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

PubMed

Morgan, Steve; Kennedy, Jae

2010-06-01

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

State variation in HIV/AIDS health outcomes: the effect of spending on social services and public health.

PubMed

Talbert-Slagle, Kristina M; Canavan, Maureen E; Rogan, Erika M; Curry, Leslie A; Bradley, Elizabeth H

2016-02-20

Despite considerable advances in the prevention and treatment of HIV/AIDS, the burden of new infections of HIV and AIDS varies substantially across the country. Previous studies have demonstrated associations between increased healthcare spending and better HIV/AIDS outcomes; however, less is known about the association between spending on social services and public health spending and HIV/AIDS outcomes. We sought to examine the association between state-level spending on social services and public health and HIV/AIDS case rates and AIDS deaths across the United States. We conducted a retrospective, longitudinal study of the 50 U.S. states over 2000-2009 using a dataset of HIV/AIDS case rates and AIDS deaths per 100 000 people matched with a unique dataset of state-level spending on social services and public health per person in poverty. We estimated multivariable regression models for each HIV/AIDS outcome as a function of the social service and public health spending 1 and 5 years earlier in the state, adjusted for the log of state GDP per capita, regional and time fixed effects, Medicaid spending as % of GDP, and socio-demographic, economic, and health resource factors. States with higher spending on social services and public health per person in poverty had significantly lower HIV and AIDS case rates and fewer AIDS deaths, both 1 and 5 years post expenditure (P ≤ 0.05). Our findings suggest that spending on social services and public health may provide a leverage point for state policymakers to reduce HIV/AIDS case rates and AIDS deaths in their state.

Public Spending on Health Service and Policy Research in Canada, the United Kingdom, and the United States: A Modest Proposal

PubMed Central

Thakkar, Vidhi; Sullivan, Terrence

2017-01-01

Health services and policy research (HSPR) represent a multidisciplinary field which integrates knowledge from health economics, health policy, health technology assessment, epidemiology, political science among other fields, to evaluate decisions in health service delivery. Health service decisions are informed by evidence at the clinical, organizational, and policy level, levels with distinct, managerial drivers. HSPR has an evolving discourse spanning knowledge translation, linkage and exchange between research and decision-maker partners and more recently, implementation science and learning health systems. Local context is important for HSPR and is important in advancing health reform practice. The amounts and configuration of national investment in this field remain important considerations which reflect priority investment areas. The priorities set within this field or research may have greater or lesser effects and promise with respect to modernizing health services in pursuit of better value and better population outcomes. Within Canada an asset map for HSPR was published by the national HSPR research institute. Having estimated publicly-funded research spending in Canada, we sought identify best available comparable estimates from the United States and the United Kingdom. Investments from industry and charitable organizations were not included in these numbers. This commentary explores spending by the United States, Canada, and the United Kingdom on HSPR as a fraction of total public spending on health and the importance of these respective investments in advancing health service performance. Proposals are offered on the merits of common nomenclature and accounting for areas of investigation in pursuit of some comparable way of assessing priority HSPR investments and suggestions for earmarking such investments to total investment in health services spending. PMID:29179288

Essays in Health Economics and Health Information Systems

ERIC Educational Resources Information Center

Terrizzi, Sabrina Ann

2013-01-01

The accelerating cost of healthcare in the United States has prompted increased policy debate. Although it is estimated that prescription drug spending accounts for only eleven percent of total healthcare expenditures, there is evidence that this rate of spending is increasing faster than spending on other types of healthcare. A proven method of…

The (paper) work of medicine: understanding international medical costs.

PubMed

Cutler, David M; Ly, Dan P

2011-01-01

This paper draws on international evidence on medical spending to examine what the United States can learn about making its healthcare system more efficient. We focus primarily on understanding contemporaneous differences in the level of spending, generally from the 2000s. Medical spending differs across countries either because the price of services differs (for example, a coronary bypass surgery operation may cost more in the United States than in other countries) or because people receive more services in some countries than in others (for example, more bypass surgery operations). Within the price category, there are two further issues: whether factors earn different returns across countries and whether more clinical or administrative personnel are required to deliver the same care in different countries. We first present the results of a decomposition of healthcare spending along these lines in the United States and in Canada. We then delve into each component in more detail—administrative costs, factor prices, and the provision of care received—bringing in a broader range of international evidence when possible. Finally, we touch upon the organization of primary and chronic disease care and discuss possible gains in that area.

Impact of Federal Spending Cuts on Maternal and Child Health Care. Hearing before the Subcommittee on Economic Goals and Intergovernmental Policy of the Joint Economic Committee. Congress of the United States, Ninety-Eighth Congress, First Session (November 17, 1983).

ERIC Educational Resources Information Center

Joint Economic Committee, Washington, DC.

The second in a series investigating child and maternal health care in the United States, this hearing explores the social impact of the 1981 spending cuts in funds for the federal maternal and child health block grant program. Statements from three senators describe the legislative history and successes of the program and detail the senators'…

Personal health care expenditures, by State: 1966-82

PubMed Central

Levit, Katharine R.

1985-01-01

Spending per capita for health care in the United States varies dramatically by State and region. In 1982, personal health care costs per capita ranged from a low of $857 in South Carolina to a high of $1,508 in Massachusetts. The focus of this article is State and regional variation in spending levels and the mix of health care services purchased. Possible causes for these differences are presented. PMID:10311335

International prices and availability of pharmaceuticals in 2005.

PubMed

Danzon, Patricia M; Furukawa, Michael F

2008-01-01

This paper compares pharmaceutical spending, availability, use, and prices in twelve countries in 2005. Drug spending per capita was higher in the United States than in other countries. The United States had relatively high use of new drugs and high-strength formulations; other countries used more of older drugs and weaker formulations. Thus, whether U.S. overall volume of use is lower or higher depends on the measure of volume and type of product. Comprehensive price indexes show foreign prices to be 20-40 percent lower than U.S. manufacturer prices, but only 10-30 percent lower than U.S. public prices. Generics are cheaper in the United States than in other countries.

New analysis reexamines the value of cancer care in the United States compared to Western Europe.

PubMed

Soneji, Samir; Yang, JaeWon

2015-03-01

Despite sharp increases in spending on cancer treatment since 1970 in the United States compared to Western Europe, US cancer mortality rates have decreased only modestly. This has raised questions about the additional value of US cancer care derived from this additional spending. We calculated the number of US cancer deaths averted, compared to the situation in Western Europe, between 1982 and 2010 for twelve cancer types. We also assessed the value of US cancer care, compared to that in Western Europe, by estimating the ratio of additional spending on cancer to the number of quality-adjusted life-years saved. Compared to Western Europe, for three of the four costliest US cancers-breast, colorectal, and prostate-there were approximately 67,000, 265,000, and 60,000 averted US deaths, respectively, and for lung cancer there were roughly 1,120,000 excess deaths in the study period. The ratio of incremental cost to quality-adjusted life-years saved equaled $402,000 for breast cancer, $110,000 for colorectal cancer, and $1,979,000 for prostate cancer-amounts that exceed most accepted thresholds for cost-effective medical care. The United States lost quality-adjusted life-years despite additional spending for lung cancer: -$19,000 per quality-adjusted life-year saved. Our results suggest that cancer care in the United States may provide less value than corresponding cancer care in Western Europe for many leading cancers. Project HOPE—The People-to-People Health Foundation, Inc.

Who pays for health care in the United States? Implications for health system reform.

PubMed

Holahan, J; Zedlewski, S

1992-01-01

This paper examines the distribution of health care spending and financing in the United States. We analyze the distribution of employer and employee contributions to health insurance, private nongroup health insurance purchases, out-of-pocket expenses, Medicaid benefits, uncompensated care, tax benefits due to the exemption of employer-paid health benefits, and taxes paid to finance Medicare, Medicaid, and the health benefit tax exclusion. All spending and financing burdens are distributed across the U.S. population using the Urban Institute's TRIM2 microsimulation model. We then examine the distributional effects of the U.S. health care system across income levels, family types, and regions of the country. The results show that health care spending increases with income. Spending for persons in the highest income deciles is about 60% above that of persons in the lowest decile. Nonetheless, the distribution of health care financing is regressive. When direct spending, employer contributions, tax benefits, and tax spending are all considered, the persons in the lowest income deciles devote nearly 20% of cash income to finance health care, compared with about 8% for persons in the highest income decile. We discuss how alternative health system reform approaches are likely to change the distribution of health spending and financing burdens.

State tobacco control expenditures and tax paid cigarette sales

PubMed Central

Tauras, John A.; Xu, Xin; Huang, Jidong; King, Brian; Lavinghouze, S. Rene; Sneegas, Karla S.; Chaloupka, Frank J.

2018-01-01

This research is the first nationally representative study to examine the relationship between actual state-level tobacco control spending in each of the 5 CDC’s Best Practices for Comprehensive Tobacco Control Program categories and cigarette sales. We employed several alternative two-way fixed-effects regression techniques to estimate the determinants of cigarette sales in the United States for the years 2008–2012. State spending on tobacco control was found to have a negative and significant impact on cigarette sales in all models that were estimated. Spending in the areas of cessation interventions, health communication interventions, and state and community interventions were found to have a negative impact on cigarette sales in all models that were estimated, whereas spending in the areas of surveillance and evaluation, and administration and management were found to have negative effects on cigarette sales in only some models. Our models predict that states that spend up to seven times their current levels could still see significant reductions in cigarette sales. The findings from this research could help inform further investments in state tobacco control programs. PMID:29652890

Public Spending on Health Service and Policy Research in Canada, the United Kingdom, and the United States: A Modest Proposal.

PubMed

Thakkar, Vidhi; Sullivan, Terrence

2017-04-10

Health services and policy research (HSPR) represent a multidisciplinary field which integrates knowledge from health economics, health policy, health technology assessment, epidemiology, political science among other fields, to evaluate decisions in health service delivery. Health service decisions are informed by evidence at the clinical, organizational, and policy level, levels with distinct, managerial drivers. HSPR has an evolving discourse spanning knowledge translation, linkage and exchange between research and decision-maker partners and more recently, implementation science and learning health systems. Local context is important for HSPR and is important in advancing health reform practice. The amounts and configuration of national investment in this field remain important considerations which reflect priority investment areas. The priorities set within this field or research may have greater or lesser effects and promise with respect to modernizing health services in pursuit of better value and better population outcomes. Within Canada an asset map for HSPR was published by the national HSPR research institute. Having estimated publicly-funded research spending in Canada, we sought identify best available comparable estimates from the United States and the United Kingdom. Investments from industry and charitable organizations were not included in these numbers. This commentary explores spending by the United States, Canada, and the United Kingdom on HSPR as a fraction of total public spending on health and the importance of these respective investments in advancing health service performance. Proposals are offered on the merits of common nomenclature and accounting for areas of investigation in pursuit of some comparable way of assessing priority HSPR investments and suggestions for earmarking such investments to total investment in health services spending. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

48 CFR 752.7031 - Leave and holidays.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., the Commonwealth of Puerto Rico, or the possessions of the United States; any days spent elsewhere...) or paragraph (c)(3) of this clause shall include the actual days spent in orientation in the United... necessary by the Contractor, regular employees in the United States on home leave may be authorized to spend...

48 CFR 752.7031 - Leave and holidays.

Code of Federal Regulations, 2012 CFR

2012-10-01

..., the Commonwealth of Puerto Rico, or the possessions of the United States; any days spent elsewhere...) or paragraph (c)(3) of this clause shall include the actual days spent in orientation in the United... necessary by the Contractor, regular employees in the United States on home leave may be authorized to spend...

48 CFR 752.7031 - Leave and holidays.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., the Commonwealth of Puerto Rico, or the possessions of the United States; any days spent elsewhere...) or paragraph (c)(3) of this clause shall include the actual days spent in orientation in the United... necessary by the Contractor, regular employees in the United States on home leave may be authorized to spend...

An analysis of whether higher health care spending in the United States versus Europe is 'worth it' in the case of cancer.

PubMed

Philipson, Tomas; Eber, Michael; Lakdawalla, Darius N; Corral, Mitra; Conti, Rena; Goldman, Dana P

2012-04-01

The United States spends more on health care than other developed countries, but some argue that US patients do not derive sufficient benefit from this extra spending. We studied whether higher US cancer care costs, compared with those of ten European countries, were "worth it" by looking at the survival differences for cancer patients in these countries compared to the relative costs of cancer care. We found that US cancer patients experienced greater survival gains than their European counterparts; even after considering higher US costs, this investment generated $598 billion of additional value for US patients who were diagnosed with cancer between 1983 and 1999. The value of that additional survival gain was highest for prostate cancer patients ($627 billion) and breast cancer patients ($173 billion). These findings do not appear to have been driven solely by earlier diagnosis. Our study suggests that the higher-cost US system of cancer care delivery may be worth it, although further research is required to determine what specific tools or treatments are driving improved cancer survival in the United States.

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.

Integrated health system for chronic disease management: lessons learned from France.

PubMed

Stuart, Mary; Weinrich, Michael

2004-02-01

Rated number one in overall health system performance by the World Health Organization, the French spend less than half the amount on annual health care per capita that the United States spends. One contributing factor may be the attention given to chronic care. Since the mid-1900s, the French have developed regional community-based specialty systems for patients with chronic respiratory insufficiency or failure. COPD is the major cause of respiratory failure, the fourth leading cause of death in the United States, and its prevalence is increasing. Despite the clinical success of home mechanical ventilation and the potential for cost savings, providing such services in the United States remains a challenge. Lessons from France can inform the development of cost-effective chronic care models in the United States In this article, we review the French experience in the context of the United States Supreme Court's Olmstead decision, mandating that people in "more restrictive settings" such as nursing homes be offered community-based supports. We suggest that regional demonstration projects for patients with chronic respiratory failure or insufficiency can provide an important step in the development of effective chronic care systems in the United States

Local Medicaid home- and community-based services spending and nursing home admissions of younger adults.

PubMed

Thomas, Kali S; Keohane, Laura; Mor, Vincent

2014-11-01

We used fixed-effect models to examine the relationship between local spending on home- and community-based services (HCBSs) for cash-assisted Medicaid-only disabled (CAMOD) adults and younger adult admissions to nursing homes in the United States during 2001 through 2008, with control for facility and market characteristics and secular trends. We found that increased CAMOD Medicaid HCBS spending at the local level is associated with decreased admissions of younger adults to nursing homes. Our findings suggest that states' efforts to expand HCBS for this population should continue.

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

Concerns Around Budget Impact Thresholds: Not All Drugs Are the Same.

PubMed

Ciarametaro, Michael; Abedi, Susan; Sohn, Adam; Ge, Colin Fan; Odedara, Neel; Dubois, Robert

2017-02-01

The use of budget thresholds is a recent development in the United States (e.g., the Institute for Clinical and Economic Review drug assessments). Budget thresholds establish limits that require some type of budgetary action if exceeded. This research focused on the advisability of using product-level budget thresholds as fixed spending caps by examining whether they are likely to improve or worsen market efficiency over status quo. The aim of this study was to determine whether fixed product-level spending caps are advisable for biopharmaceuticals. We systematically examined 5-year, postlaunch revenue for drugs that launched in the United States between 2003 and 2014 using the IMS MIDAS database. For products launched between 2011 and 2014, we used historical revenue as the baseline and trended out 60 months postlaunch based on exponential smoothing. Forecasted fifth-year revenue was compared to analyst reports. Fifth-year revenue was compared against a hypothetical $904 million spending cap to determine the amount of annual spending that might require reallocation. Descriptive statistics of 5-year, postlaunch revenue and annual spending requiring reallocation were calculated. Adhering to a $904 million product-level spending cap requires that approximately one-third of new drug spending be reallocated to other goods and services that have the potential to be less cost-effective due to significant barriers. Fixed product-level spending caps have the potential to reduce market efficiency due to their independence from value and the presence of important operational challenges. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Trends in Spending by the Department of Defense for Operation and Maintenance

DTIC Science & Technology

2017-01-01

CONGRESS OF THE UNITED STATES CONGRESSIONAL BUDGET OFFICE CBO Trends in Spending by the Department of Defense for Operation and Maintenance JANUARY 2017...Funding? g the Growth in O&M Funding cheme gorization Scheme in Explaining Trends in O&M Funding ed ration and Maintenance Between 1980 and 2015 Maintenance ...by Category of Spending ration and Maintenance Between 2000 and 2012, by Category From 2000 to 2012 in Categories That Are Difficult to Track CBO

Shortchanging Education: A Case Study in Flawed Economics. Technical Assessment.

ERIC Educational Resources Information Center

Department of Education, Washington, DC. Office of Planning, Budget, and Evaluation.

The Economic Policy Institute (EPI) study, by measuring comparative education spending levels between the United States and other industrialized nations, shifts the focus of the education debate from the critical issue of how to reform American's education system to matching spending with other nations. The EPI calculates a country's education…

Agents of Change for Health Care Reform

ERIC Educational Resources Information Center

Buchanan, Larry M.

2007-01-01

It is widely recognized throughout the health care industry that the United States leads the world in health care spending per capita. However, the chilling dose of reality for American health care consumers is that for all of their spending, the World Health Organization ranks the country's health care system 37th in overall performance--right…

Inequalities in Parental Spending on Young Children: 1980-2010

ERIC Educational Resources Information Center

Kornrich, Sabino

2016-01-01

Using 1972-2000 data from the Consumer Expenditure Survey (CES), a nationally representative survey of spending conducted by the Bureau of Labor Statistics, this paper investigates changes in the income-based gap in monetary investments in children under the age of six, when most children typically have entered school in the United States. The…

Targets for Marine Corps Purchasing and Supply Management Initiatives: Spend Analysis Findings

DTIC Science & Technology

2011-01-01

TRANSPORTATION INTERNATIONAL AFFAIRS LAW AND BUSINESS NATIONAL SECURITY POPULATION AND AGING PUBLIC SAFETY SCIENCE AND TECHNOLOGY TERRORISM AND...States Transportation Command UNICOR Federal Prison Industries, Inc. USMC United States Marine Corps WHS/SIAD Washington Headquarters Services...Services Admin- istration (GSA), and the United States Transportation Command (TRANSCOM), as well as via Military Interdepartmental Purchase Requests

The financial burden of out-of-pocket expenses in the United States and Canada: How different is the United States?

PubMed Central

Baird, Katherine E

2016-01-01

Background: This article compares the burden that medical cost-sharing requirements place on households in the United States and Canada. It estimates the probability that individuals with similar demographic features in the two countries have large medical expenses relative to income. Method: The study uses 2010 nationally representative household survey data harmonized for cross-national comparisons to identify individuals with high medical expenses relative to income. Using logistic regression, it estimates the probability of high expenses occurring among 10 different demographic groups in the two countries. Results: The results show the risk of large medical expenses in the United States is 1.5–4 times higher than it is in Canada, depending on the demographic group and spending threshold used. The United States compares least favorably when evaluating poorer citizens and when using a higher spending threshold. Conclusion: Recent health care reforms can be expected to reduce Americans’ catastrophic health expenses, but it will take very large reductions in out-of-pocket expenditures—larger than can be expected—if poorer and middle-class families are to have the financial protection from high health care costs that their counterparts in Canada have. PMID:26985389

Adjusting health spending for the presence of comorbidities: an application to United States national inpatient data.

PubMed

Dieleman, Joseph L; Baral, Ranju; Johnson, Elizabeth; Bulchis, Anne; Birger, Maxwell; Bui, Anthony L; Campbell, Madeline; Chapin, Abigail; Gabert, Rose; Hamavid, Hannah; Horst, Cody; Joseph, Jonathan; Lomsadze, Liya; Squires, Ellen; Tobias, Martin

2017-08-29

One of the major challenges in estimating health care spending spent on each cause of illness is allocating spending for a health care event to a single cause of illness in the presence of comorbidities. Comorbidities, the secondary diagnoses, are common across many causes of illness and often correlate with worse health outcomes and more expensive health care. In this study, we propose a method for measuring the average spending for each cause of illness with and without comorbidities. Our strategy for measuring cause of illness-specific spending and adjusting for the presence of comorbidities uses a regression-based framework to estimate excess spending due to comorbidities. We consider multiple causes simultaneously, allowing causes of illness to appear as either a primary diagnosis or a comorbidity. Our adjustment method distributes excess spending away from primary diagnoses (outflows), exaggerated due to the presence of comorbidities, and allocates that spending towards causes of illness that appear as comorbidities (inflows). We apply this framework for spending adjustment to the National Inpatient Survey data in the United States for years 1996-2012 to generate comorbidity-adjusted health care spending estimates for 154 causes of illness by age and sex. The primary diagnoses with the greatest number of comorbidities in the NIS dataset were acute renal failure, septicemia, and endocarditis. Hypertension, diabetes, and ischemic heart disease were the most common comorbidities across all age groups. After adjusting for comorbidities, chronic kidney diseases, atrial fibrillation and flutter, and chronic obstructive pulmonary disease increased by 74.1%, 40.9%, and 21.0%, respectively, while pancreatitis, lower respiratory infections, and septicemia decreased by 21.3%, 17.2%, and 16.0%. For many diseases, comorbidity adjustments had varying effects on spending for different age groups. Our methodology takes a unified approach to account for excess spending caused by the presence of comorbidities. Adjusting for comorbidities provides a substantially altered, more accurate estimate of the spending attributed to specific cause of illness. Making these adjustments supports improved resource tracking, accountability, and planning for future resource allocation.

Boosting Educational Attainment and Adult Earnings: Does School Spending Matter after All?

ERIC Educational Resources Information Center

Jackson, C. Kirabo; Johnson, Rucker C.; Persico, Claudia

2015-01-01

This study addresses limitations in a study conducted by James Coleman in 1966, which analyzed aspects of educational equality in the United States--including the relationship between school spending and student outcomes--as well as other studies covering the same topic that stemmed from Coleman's Report. Coleman found that variation in school…

Healthy Schools: Lessons for a Clean Educational Environment

ERIC Educational Resources Information Center

US Environmental Protection Agency, 2008

2008-01-01

More than 53 million children and 6 million adults in the United States spend their days in elementary and secondary schools. Reducing environmental risks inside these buildings is critical to maintaining the public health. Almost all of New England's children will spend a large portion of their childhood in school. To help children stay healthy,…

Vocational Education at the Crossroads.

ERIC Educational Resources Information Center

Merkel-Keller, Claudia

The United States faces stiff global competition in the marketplace of the future as other countries such as Germany, Japan, and the nations of the Pacific rim produce better products with a more skilled work force. Germany and Japan spend far more resources on job training for their youth than does the United States, especially on training…

Emotional Intelligence: A Key to Improving Federal Chief Information Officer Management

ERIC Educational Resources Information Center

Borkowski, Tammy M.

2012-01-01

The United States Government relies on information technology to provide services to its citizens, spending more than $600 billion on its products and services in the last decade. Given the current fiscal climate, the Executive Branch of the United States Government has a renewed focus on information technology (IT) innovation, requiring federal…

One size fits all? Disentangling the effects of tobacco taxes, laws, and control spending on adult subgroups in the United States.

PubMed

Yu, Hao; Engberg, John; Scharf, Deborah

2018-03-07

To determine the relative impact of each of the 3 state-level tobacco control policies (cigarette taxation, tobacco control spending, and smoke-free air [SFA] laws) on adult smoking rate overall and separately for adult subgroups in the United States. A difference-in-differences analysis was conducted with generalized propensity scores. State-level policies were merged with the individual-level Behavioral Risk Factor Surveillance System in 1995-2009. State cigarette taxation was the only policy that significantly impacted smoking among the general adult population, with a 1-standard deviation increase in taxes (i.e., $0.68 in constant 2014 dollars) lowering the adult smoking rate by about a quarter of a percentage point. The taxation impact was consistent, regardless of the presence of, or interactions with, other policies. Taxation was also the only policy that significantly reduced smoking for some adult subgroups, including females, non-Hispanic whites, adults aged 51 or older, and adults with more than a high school education. However, other adult subgroups responded to the other 2 types of policies, either by mediating the taxation effect or by reducing smoking independently. Specifically, tobacco control spending reduced smoking among young adults (ages 18-25 years) and Hispanics. SFA laws affected smoking among men, young adults, non-Hispanic blacks, and Hispanics. State cigarette taxation is the single most important policy for reducing smoking among the general adult population. However, adult subgroups' reactions to taxes are diverse and mediated by tobacco control spending and SFA laws.

Birding economics and birder demographics studies as conservation tools

Treesearch

Paul Kerlinger

1993-01-01

Birders are the primary user-group of neotropical migratory birds. In the United States, birders number in the tens of millions and spend upwards of $20 billion dollars per year on bird seed, travel, and birding paraphernalia. Average yearly spending by active birders averages between $1,500 and $3,400, with travel being the major expenditure. Research needs include...

US Spending On Complementary And Alternative Medicine During 2002–08 Plateaued, Suggesting Role In Reformed Health System

PubMed Central

Davis, Matthew A.; Martin, Brook I.; Coulter, Ian D.; Weeks, William B.

2013-01-01

Complementary and alternative medicine services in the United States are an approximately $9 billion market each year, equal to 3 percent of national ambulatory health care expenditures. Unlike conventional allopathic health care, complementary and alternative medicine is primarily paid for out of pocket, although some services are covered by most health insurance. Examining trends in demand for complementary and alternative medicine services in the United States reported in the Medical Expenditure Panel Survey during 2002–08, we found that use of and spending on these services, previously on the rise, have largely plateaued. The higher proportion of out-of-pocket responsibility for payment for services may explain the lack of growth. Our findings suggest that any attempt to reduce national health care spending by eliminating coverage for complementary and alternative medicine would have little impact at best. Should some forms of complementary and alternative medicine—for example, chiropractic care for back pain—be proven more efficient than allopathic and specialty medicine, the inclusion of complementary and alternative medicine providers in new delivery systems such as accountable care organizations could help slow growth in national health care spending. PMID:23297270

78 FR 76282 - Secretarial Infrastructure Business Development Mission to the United Arab Emirates, the Kingdom...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-17

... new communities. The government is committed to continue to spend heavily in the education, health... relationship is going through a massive transformation. The United States posted a trade surplus with Qatar of...

78 FR 76818 - Secretarial Infrastructure Business Development Mission to the United Arab Emirates, the Kingdom...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-19

... new communities. The government is committed to continue to spend heavily in the education, health... going through a massive transformation. The United States posted a trade surplus with Qatar of $2.6...

State of the States in Developmental Disabilities

ERIC Educational Resources Information Center

Braddock, David; Hemp, Richard; Rizzolo, Mary Kay

2008-01-01

This is the latest edition of the "State of the States in Developmental Disabilities" study--a thorough and the only one of its kind investigation on public spending, revenues, and programmatic trends of intellectual and developmental programs and services within the United States since 1977. Directed by leading researcher, Dr. David…

National Health Expenditures, 1996

PubMed Central

Levit, Katharine R.; Lazenby, Helen C.; Braden, Bradley R.; Cowan, Cathy A.; Sensenig, Arthur L.; McDonnell, Patricia A.; Stiller, Jean M.; Won, Darleen K.; Martin, Anne B.; Sivarajan, Lekha; Donham, Carolyn S.; Long, Anna M.; Stewart, Madie W.

1997-01-01

The national health expenditures (NHE) series presented in this report for 1960-96 provides a view of the economic history of health care in the United States through spending for health care services and the sources financing that care. In 1996 NHE topped $1 trillion. At the same time, spending grew at the slowest rate, 4.4 percent, ever recorded in the current series. For the first time, this article presents estimates of Medicare managed care payments by type of service, as well as nursing home and home health spending in hospital-based facilities. PMID:10179997

The state of domestic affairs: Housework, gender and state-level institutional logics.

PubMed

Ruppanner, Leah; Maume, David J

2016-11-01

Multi-level cross-national research consistently shows individual housework arrangements are structured by broader contexts of equality. Across this body of research, the United States is treated as a single entity. Yet, individual-level housework time may vary by state-to-state differences in institutional market, family and legislative logics. To test these relationships, we pair individual-level data from the American Time Use Survey (2003-2012; aged 18 to 64 n = 106,190) with three state-level indices - female labor force empowerment, family traditionalism and state government liberalism. For market institutional logics, we find wives and husbands spend more but mothers less time in housework in states where women have more labor market power. For family logics, we find mothers spend more and husbands less time in housework in more traditional states. For legislative logics, we find women and husbands spend more time in housework in more liberal states. Our results highlight the importance of state-to-state institutional logics on individuals' housework time. Copyright © 2016 Elsevier Inc. All rights reserved.

Hard Times. The Recession Imperils School Reforms and Teachers' Jobs.

ERIC Educational Resources Information Center

Harp, Lonnie

1991-01-01

The current recession in the United States imperils teachers' jobs and school reform. States are prioritizing increased spending in such areas as health care and transportation rather than educational improvement. The article discusses specific educational hard times in several states and counties. (SM)

Growth in spending on substance use disorder treatment services for the privately insured population.

PubMed

Thomas, Cindy Parks; Hodgkin, Dominic; Levit, Katharine; Mark, Tami L

2016-03-01

Approximately 8% of individuals with private health insurance in the United States have substance use disorders (SUDs), but in 2009 only 0.4% of all private insurance spending was on SUDs. The objective of this study was to determine if changes that occurred between 2009 and 2012 - such as more generous SUD benefits, an epidemic of opioid use disorders, and slow recovery from a recession - were associated with greater use of SUD treatment. Data were from the 2004-2012 Truven Health Analytics MarketScan(®) Commercial Claims and Encounters Database. This database is representative of individuals with private insurance in the United States. Per enrollee use of and spending on SUD treatment was determined and compared with spending on all health care services. Trends were examined for inpatient care, outpatient care, and prescription medications. During the 2009-2012 time period, use of and spending on SUD services increased compared with all diagnoses. Two-thirds of the increase was driven by higher growth rates in outpatient use and prices. Despite the high growth rates, SUD treatment penetration rates remained low. As of 2012, only 0.6% of individuals with private insurance used SUD outpatient services, 0.2% filled SUD medication prescriptions, and 0.1% used inpatient SUD services. In 2012, SUD services accounted for less than 0.7% of all private insurance spending. Despite recent coverage improvements, individuals with private health insurance still may not receive adequate levels of treatment for SUDs, as evidenced by the small proportion of individuals who access treatment. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

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

PubMed

Stewart, Louis J

2012-01-01

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

History and the End of the Cold War: A Whole New Ball Game?

ERIC Educational Resources Information Center

Clifford, J. Garry

1992-01-01

Contends end of the Cold War and demise of communism caught most historians by surprise. Questions whether increased military spending by Unites States was the primary cause of the fall of the Soviet Union and communist nations in Europe. Argues world is still a dangerous place, and the Unites States must be diplomatically skillful and encourage…

Patterns, Trends and Policy Implications of Private Spending on Skills Development in Mexico and the United States

ERIC Educational Resources Information Center

Székely, Miguel; Mendoza, Pamela

2017-01-01

This paper explores families' investment in skills development through education in a high-inequality, low-education quality country such as Mexico, comparing it to a lower-inequality, higher-quality education country such as the United States. The paper uses a series of Household Income and Expenditure Surveys for both countries spanning around…

Public health and the economy could be served by reallocating medical expenditures to social programs.

PubMed

Tran, Linda Diem; Zimmerman, Frederick J; Fielding, Jonathan E

2017-12-01

As much as 30% of US health care spending in the United States does not improve individual or population health. To a large extent this excess spending results from prices that are too high and from administrative waste. In the public sector, and particularly at the state level, where budget constraints are severe and reluctance to raise taxes high, this spending crowds out social, educational, and public-health investments. Over time, as spending on medical care increases, spending on improvements to the social determinants of health are starved. In California the fraction of General Fund expenditures spent on public health and social programs fell from 34.8% in fiscal year 1990 to 21.4% in fiscal year 2014, while health care increased from 14.1% to 21.3%. In spending more on healthcare and less on other efforts to improve health and health determinants, the state is missing important opportunities for health-promoting interventions with a strong financial return. Reallocating ineffective medical expenditures to proven and cost-effective public health and social programs would not be easy, but recognizing its potential for improving the public's health while saving taxpayers billions of dollars might provide political cover to those willing to engage in genuine reform. National estimates of the percent of medical spending that does not improve health suggest that approximately $5 billion of California's public budget for medical spending has no positive effect on health. Up to 10,500 premature deaths could be prevented annually by reallocating this portion of medical spending to public health. Alternatively, the same expenditure could help an additional 418,000 high school students to graduate.

Local Medicaid Home- and Community-Based Services Spending and Nursing Home Admissions of Younger Adults

PubMed Central

Keohane, Laura; Mor, Vincent

2014-01-01

We used fixed-effect models to examine the relationship between local spending on home- and community-based services (HCBSs) for cash-assisted Medicaid-only disabled (CAMOD) adults and younger adult admissions to nursing homes in the United States during 2001 through 2008, with control for facility and market characteristics and secular trends. We found that increased CAMOD Medicaid HCBS spending at the local level is associated with decreased admissions of younger adults to nursing homes. Our findings suggest that states’ efforts to expand HCBS for this population should continue. PMID:25211711

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…

Where Money Mattered: Organizational and Economic Consequences of State Public School Expenditures in the United States: 1880-1940.

ERIC Educational Resources Information Center

Balfanz, Robert

1997-01-01

Uses historical, state-level schooling data, manufacturing productivity measures, and quantitative research to examine relationships between changes in rate and distribution of public school expenditures, public schooling organization, and state-level economic growth from 1880-1940. Significant effects for per-student spending on school…

CUE - Kadenyuk checks the status of the PGCs in the middeck PGF locker

NASA Image and Video Library

1998-01-15

STS087-385-005 (19 November - 5 December 1997) --- Leonid Kadenyuk, Ukrainian payload specialist, retrieves a plant specimen from the plant growth facility on the mid-deck of the Earth-orbiting Space Shuttle Columbia. Kadenyuk and five United States astronauts went on to spend 16-days in Earth-orbit in support of the United States Microgravity Payload (USMP-4) mission.

Change in the southern U.S. water demand and supply over the next forty years

Treesearch

Steven C. McNulty; Ge Sun; Erika C. Cohen; Jennifer A. Moore Myers

2008-01-01

Water shortages are often considered a problem in the western United States, where water supply is limited compared to the eastern half of the country. However, periodic water shortages are also common in the southeastern United States due to high water demand and periodic drought. Southeastern U.S. municipalities spend billions of dollars to develop water storage...

National Health Expenditure Projections, 2015-25: Economy, Prices, And Aging Expected To Shape Spending And Enrollment.

PubMed

Keehan, Sean P; Poisal, John A; Cuckler, Gigi A; Sisko, Andrea M; Smith, Sheila D; Madison, Andrew J; Stone, Devin A; Wolfe, Christian J; Lizonitz, Joseph M

2016-08-01

Health spending growth in the United States for 2015-25 is projected to average 5.8 percent-1.3 percentage points faster than growth in the gross domestic product-and to represent 20.1 percent of the total economy by 2025. As the initial impacts associated with the Affordable Care Act's coverage expansions fade, growth in health spending is expected to be influenced by changes in economic growth, faster growth in medical prices, and population aging. Projected national health spending growth, though faster than observed in the recent history, is slower than in the two decades before the recent Great Recession, in part because of trends such as increasing cost sharing in private health insurance plans and various Medicare payment update provisions. In addition, the share of total health expenditures paid for by federal, state, and local governments is projected to increase to 47 percent by 2025. Project HOPE—The People-to-People Health Foundation, Inc.

Education Issues. Transition Series.

ERIC Educational Resources Information Center

Comptroller General of the U.S., Washington, DC.

The United States educational system is not meeting the increasing demand for highly skilled workers required in the international marketplace. While local, state, and federal governments spend $221 billion on public elementary and secondary education, only a small percentage of the nation's students have adequate reasoning and problem-solving…

DataView: National Health Expenditures, 1994

PubMed Central

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

1996-01-01

This article presents data on health care spending for the United States, covering expenditures for various types of medical services and products and their sources of funding from 1960 to 1994. Although these statistics for 1994 show the slowest growth in more than three decades, health spending continued to grow faster than the overall economy. The Federal Government continued to fund an increasing share of health care expenditures in 1994, offset by a falling share from out-of-pocket sources. Shares paid by State and local governments and by other private payers including private health insurance remained unchanged from 1993. PMID:10158731

The Future of Utility Customer-Funded Energy Efficiency Programs in the United States: Projected Spending and Savings to 2025

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

Barbose, Galen; Goldman, Charles; Hoffman, Ian

2012-09-11

We develop projections of future spending on, and savings from, energy efficiency programs funded by electric and gas utility customers in the United States, under three scenarios through 2025. Our analysis, which updates a previous LBNL study, relies on detailed bottom-up modeling of current state energy efficiency policies, regulatory decisions, and demand-side management and utility resource plans. The three scenarios are intended to represent a range of potential outcomes under the current policy environment (i.e., without considering possible major new policy developments). By 2025, spending on electric and gas efficiency programs (excluding load management programs) is projected to double frommore » 2010 levels to $9.5 billion in the medium case, compared to $15.6 billion in the high case and $6.5 billion in the low case. Compliance with statewide legislative or regulatory savings or spending targets is the primary driver for the increase in electric program spending through 2025, though a significant share of the increase is also driven by utility DSM planning activity and integrated resource planning. Our analysis suggests that electric efficiency program spending may approach a more even geographic distribution over time in terms of absolute dollars spent, with the Northeastern and Western states declining from over 70% of total U.S. spending in 2010 to slightly more than 50% in 2025, with the South and Midwest splitting the remainder roughly evenly. Under our medium case scenario, annual incremental savings from customer-funded electric energy efficiency programs increase from 18.4 TWh in 2010 in the U.S. (which is about 0.5% of electric utility retail sales) to 28.8 TWh in 2025 (0.8% of retail sales). These savings would offset the majority of load growth in the Energy Information Administration’s most recent reference case forecast, given specific assumptions about the extent to which future energy efficiency program savings are captured in that forecast. However, the pathway that customer-funded efficiency programs ultimately take will depend on a series of key challenges and uncertainties associated both with the broader market and policy context and with the implementation and regulatory oversight of the energy efficiency programs themselves.« less

Financing Community Services in the United States: Results of a Nationwide Study.

ERIC Educational Resources Information Center

Braddock, David; And Others

1987-01-01

Results of an analysis of state-federal expenditures for community services between Fiscal Years 1977 and 1984 are summarized. Important trends identified include rapid real economic growth in total nationwide community spending, in federal Intermediate Care Facility for the Mentally Retarded reimbursements, and in funds derived from state-source…

Factors Associated With Increases in US Health Care Spending, 1996-2013

PubMed Central

Squires, Ellen; Bui, Anthony L.; Campbell, Madeline; Chapin, Abigail; Hamavid, Hannah; Horst, Cody; Li, Zhiyin; Matyasz, Taylor; Reynolds, Alex; Sadat, Nafis; Schneider, Matthew T.; Murray, Christopher J. L.

2017-01-01

Importance Health care spending in the United States increased substantially from 1995 to 2015 and comprised 17.8% of the economy in 2015. Understanding the relationship between known factors and spending increases over time could inform policy efforts to contain future spending growth. Objective To quantify changes in spending associated with 5 fundamental factors related to health care spending in the United States: population size, population age structure, disease prevalence or incidence, service utilization, and service price and intensity. Design and Setting Data on the 5 factors from 1996 through 2013 were extracted for 155 health conditions, 36 age and sex groups, and 6 types of care from the Global Burden of Disease 2015 study and the Institute for Health Metrics and Evaluation’s US Disease Expenditure 2013 project. Decomposition analysis was performed to estimate the association between changes in these factors and changes in health care spending and to estimate the variability across health conditions and types of care. Exposures Change in population size, population aging, disease prevalence or incidence, service utilization, or service price and intensity. Main Outcomes and Measures Change in health care spending from 1996 through 2013. Results After adjustments for price inflation, annual health care spending on inpatient, ambulatory, retail pharmaceutical, nursing facility, emergency department, and dental care increased by $933.5 billion between 1996 and 2013, from $1.2 trillion to $2.1 trillion. Increases in US population size were associated with a 23.1% (uncertainty interval [UI], 23.1%-23.1%), or $269.5 (UI, $269.0-$270.0) billion, spending increase; aging of the population was associated with an 11.6% (UI, 11.4%-11.8%), or $135.7 (UI, $133.3-$137.7) billion, spending increase. Changes in disease prevalence or incidence were associated with spending reductions of 2.4% (UI, 0.9%-3.8%), or $28.2 (UI, $10.5-$44.4) billion, whereas changes in service utilization were not associated with a statistically significant change in spending. Changes in service price and intensity were associated with a 50.0% (UI, 45.0%-55.0%), or $583.5 (UI, $525.2-$641.4) billion, spending increase. The influence of these 5 factors varied by health condition and type of care. For example, the increase in annual diabetes spending between 1996 and 2013 was $64.4 (UI, $57.9-$70.6) billion; $44.4 (UI, $38.7-$49.6) billion of this increase was pharmaceutical spending. Conclusions and Relevance Increases in US health care spending from 1996 through 2013 were largely related to increases in health care service price and intensity but were also positively associated with population growth and aging and negatively associated with disease prevalence or incidence. Understanding these factors and their variability across health conditions and types of care may inform policy efforts to contain health care spending. PMID:29114831

Three worlds of relief: race, immigration, and public and private social welfare spending in American cities, 1929.

PubMed

Fox, Cybelle

2010-09-01

Using a data set of public and private relief spending for 295 cities, this article examines the racial and ethnic patterning of social welfare provision in the United States in 1929. On the eve of the Depression, cities with more blacks or Mexicans spent the least on social assistance and relied more heavily on private money to fund their programs. Cities with more European immigrants spent the most on relief and relied more heavily on public funding. Distinct political systems, labor market relations, and racial ideologies about each group's proclivity to use relief best explain relief spending differences across cities.

National Health Expenditures, 1993

PubMed Central

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

1994-01-01

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

Health spending in the 1980's: Integration of clinical practice patterns with management

PubMed Central

Freeland, Mark S.; Schendler, Carol E.

1984-01-01

Health care spending in the United States more than tripled between 1972 and 1982, increasing from $94 billion to $322 billion. This growth substantially outpaced overall growth in the economy. National health expenditures are projected to reach approximately $690 billion in 1990 and consume roughly 12 percent of the gross national product. Government spending for health care is projected to reach $294 billion by 1990, with the Federal Government paying 72 percent. The Medicare prospective payment system and increasing competition in the health services sector are providing incentives to integrate clinical practice patterns with improved management practices. PMID:10310595

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.

The High Cost of Prescription Drugs in the United States: Origins and Prospects for Reform.

PubMed

Kesselheim, Aaron S; Avorn, Jerry; Sarpatwari, Ameet

The increasing cost of prescription drugs in the United States has become a source of concern for patients, prescribers, payers, and policy makers. To review the origins and effects of high drug prices in the US market and to consider policy options that could contain the cost of prescription drugs. We reviewed the peer-reviewed medical and health policy literature from January 2005 to July 2016 for articles addressing the sources of drug prices in the United States, the justifications and consequences of high prices, and possible solutions. Per capita prescription drug spending in the United States exceeds that in all other countries, largely driven by brand-name drug prices that have been increasing in recent years at rates far beyond the consumer price index. In 2013, per capita spending on prescription drugs was $858 compared with an average of $400 for 19 other industrialized nations. In the United States, prescription medications now comprise an estimated 17% of overall personal health care services. The most important factor that allows manufacturers to set high drug prices is market exclusivity, protected by monopoly rights awarded upon Food and Drug Administration approval and by patents. The availability of generic drugs after this exclusivity period is the main means of reducing prices in the United States, but access to them may be delayed by numerous business and legal strategies. The primary counterweight against excessive pricing during market exclusivity is the negotiating power of the payer, which is currently constrained by several factors, including the requirement that most government drug payment plans cover nearly all products. Another key contributor to drug spending is physician prescribing choices when comparable alternatives are available at different costs. Although prices are often justified by the high cost of drug development, there is no evidence of an association between research and development costs and prices; rather, prescription drugs are priced in the United States primarily on the basis of what the market will bear. High drug prices are the result of the approach the United States has taken to granting government-protected monopolies to drug manufacturers, combined with coverage requirements imposed on government-funded drug benefits. The most realistic short-term strategies to address high prices include enforcing more stringent requirements for the award and extension of exclusivity rights; enhancing competition by ensuring timely generic drug availability; providing greater opportunities for meaningful price negotiation by governmental payers; generating more evidence about comparative cost-effectiveness of therapeutic alternatives; and more effectively educating patients, prescribers, payers, and policy makers about these choices.

49 CFR 9.1 - Purpose.

Code of Federal Regulations, 2014 CFR

2014-10-01

... litigants; (4) Avoid spending the time and money of the United States for private purposes; and (5) To... exception may be granted only when the deviation will not interfere with matters of operational or military...

49 CFR 9.1 - Purpose.

Code of Federal Regulations, 2012 CFR

2012-10-01

... litigants; (4) Avoid spending the time and money of the United States for private purposes; and (5) To... exception may be granted only when the deviation will not interfere with matters of operational or military...

49 CFR 9.1 - Purpose.

Code of Federal Regulations, 2011 CFR

2011-10-01

... litigants; (4) Avoid spending the time and money of the United States for private purposes; and (5) To... exception may be granted only when the deviation will not interfere with matters of operational or military...

49 CFR 9.1 - Purpose.

Code of Federal Regulations, 2013 CFR

2013-10-01

... litigants; (4) Avoid spending the time and money of the United States for private purposes; and (5) To... exception may be granted only when the deviation will not interfere with matters of operational or military...

49 CFR 9.1 - Purpose.

Code of Federal Regulations, 2010 CFR

2010-10-01

... litigants; (4) Avoid spending the time and money of the United States for private purposes; and (5) To... exception may be granted only when the deviation will not interfere with matters of operational or military...

78 FR 73238 - Currently Approved Information Collection: Comment Request for Customer Satisfaction and Opinion...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-05

... not a toll-free number); [email protected] . SUPPLEMENTARY INFORMATION: Title: Quantitative Consumer Research--United States Mint Customer Spend Trajectory Research Survey. OMB Number: 1525-0015...

Changes In US spending on Mental Health And Substance Abuse Treatment, 1986-2005, and implications for policy.

PubMed

Mark, Tami L; Levit, Katharine R; Vandivort-Warren, Rita; Buck, Jeffrey A; Coffey, Rosanna M

2011-02-01

The United States invests a sizable amount of money on treatments for mental health and substance abuse: $135 billion in 2005, or 1.07 percent of the gross domestic product. We provide treatment spending estimates from the period 1986-2005 to build understanding of past trends and consider future possibilities. We find that the growth rate in spending on mental health medications-a major driver of mental health expenditures in prior years-declined dramatically. As a result, mental health and substance abuse spending grew at a slightly slower rate than gross domestic product in 2004 and 2005, and it continued to shrink as a share of all health spending. Of note, we also find that Medicaid's share of total spending on mental health grew from 17 percent in 1986 to 27 percent in 2002 to 28 percent in 2005. The recent recession, the full implementation of federal parity law, and such health reform-related actions as the planned expansion of Medicaid all have the potential to improve access to mental health and substance abuse treatment and to alter spending patterns further. Our spending estimates provide an important context for evaluating the effect of those policies.

Community College-Research University Collaboration: Emerging Student Research and Transfer Partnerships

ERIC Educational Resources Information Center

Phelps, L. Allen; Prevost, Amy

2012-01-01

In settings across the United States, governing boards, state officials, and campus leaders are intensely examining, refining, and reprioritizing post-secondary education missions and spending to optimize value-added economic and social returns. In this article, the authors discuss the nation's changing research and innovation context, the…

Automated Workflow: Balancing Reduced Personnel with Web-Based Systems

ERIC Educational Resources Information Center

Armbruster, Stephanie; Strasburger, Tom

2011-01-01

The economic crisis has caused districts throughout the United States to cut resources and limit spending, particularly with regard to staff. However, the requirements for maintaining safe, efficiently functioning schools and for remaining in compliance with state and federal regulations have not decreased; in many cases, those responsibilities…

Evaluation of a Shared Services Compact in Two Rural Ohio School Districts

ERIC Educational Resources Information Center

Dziczkowski, Jennifer E.

2011-01-01

School funding adequacy is a topic that has received increased attention throughout the United States since the late 1990s. Current economic conditions, deficit spending, and burgeoning health care costs have caused school districts to compete with state governments for scarce monetary resources. Ohio is one such state. In December of 2008, the…

Welfare Reform. At Issue, An Opposing Viewpoints Series.

ERIC Educational Resources Information Center

Cozic, Charles P., Ed.

Efforts to reform the welfare system in the United States have been gaining momentum since the late 1980s. Critics have been arguing that states should receive federal waivers to create their own programs to encourage welfare recipients to find work. The thrust of the 1996 welfare reform act transfers control over welfare spending to the states.…

Compression of morbidity: a personal, research, and national fiscal solvency perspective.

PubMed

O'Donnell, Michael P

2012-01-01

Soon to be published research shows that people with positive health practices reduced the period of disability at the end of life by an estimated six to nine years. If improved health habits could reduce the period of disability for the entire population of the United States by this amount, spending on Medicare, Medicaid, and Social Security would drop substantially, and state and federal income tax revenues would increase substantially. This is critically important given that the Congressional Budget Office has projected that 100% of federal tax revenues will be consumed by Medicare, Medicaid, and Social Security by the year 2050 if current health and spending trends continue.

Health spending by state of residence, 1991-2009.

PubMed

Cuckler, Gigi; Martin, Anne; Whittle, Lekha; Heffler, Stephen; Sisko, Andrea; Lassman, Dave; Benson, Joseph

2011-12-06

Provide a detailed discussion of baseline health spending by state of residence (per capita personal health care spending, per enrollee Medicare spending, and per enrollee Medicaid spending) in 2009, over the last decade (1998-2009), as well as the differential regional and state impacts of the recent recession. State Health Expenditures by State of Residence for 1991-2009, produced by the Centers for Medicare & Medicaid Services' Office of the Actuary. In 2009, the 10 states where per capita spending was highest ranged from 13 to 36 percent higher than the national average, and the 10 states where per capita spending was lowest ranged from 8 to 26 percent below the national average. States with the highest per capita spending tended to have older populations and the highest per capita incomes; states with the lowest per capita spending tended to have younger populations, lower per capita incomes, and higher rates of uninsured. Over the last decade, the New England and Mideast regions exhibited the highest per capita personal health care spending, while states in the Southwest and Rocky Mountain regions had the lowest per capita spending. Variation in per enrollee Medicaid spending, however, has consistently been greater than that of total per capita personal health care spending or per enrollee Medicare spending from 1998-2009. The Great Lakes, New England, and Far West regions experienced the largest slowdown in per person health spending growth during the recent recession, largely as a result of higher unemployment rates. Public Domain.

The Advertising Strategies of Early E-cigarette Brand Leaders in the United States.

PubMed

Haardörfer, Regine; Cahn, Zachary; Lewis, Michael; Kothari, Shreya; Sarmah, Raina; Getachew, Betelihem; Berg, Carla J

2017-04-01

We examined differential advertising strategies used by 4 major United States e-cigarette companies with differential affiliations with the traditional tobacco industry (ie, Njoy - independent, Blu - acquired, Vuse and MarkTen - launched by cigarette companies) over time. We conducted a mixed-methods study regarding e-cigarette adspend, adspend per media channel (eg, TV, print), and advertising messaging strategies among these 4 top e-cigarette brands from January 2013 through December 2015. E-cigarette adspend increased from $59 million in 2013 to $91 million in 2014, followed by a sharp decline to $37 million in 2015. These companies showed distinct spending trajectories overall and across media channels, with Njoy and Vuse spending a higher proportion of their dollars on TV and Blu and MarkTen spending more on print. Marketing messages were also different by company. Key themes included switching from cigarettes (particularly by Njoy and Blu), circumventing smoke-free policies (particularly by Blu), and technological advancement (particularly by Vuse and MarkTen). These e-cigarette brands have shifted their adspend, use of media channels, and advertising messaging strategies over time. Some differing strategies may reflect the different affiliations of each brand to the traditional cigarette industry.

Mechanical behavior of fouled polyurethane stabilized ballast (PSB).

DOT National Transportation Integrated Search

2012-11-01

The United State (US) Department of Transportation (DOT) estimates that the demand for rail freight transportation (tonnage) will : increase 88% by 2035, North American railroads spend about $3.4 billion every year on track substructure maintenance a...

Health Spending by State of Residence, 1991–2009

PubMed Central

Cuckler, Gigi; Martin, Anne; Whittle, Lekha; Heffler, Stephen; Sisko, Andrea; Lassman, Dave; Benson, Joseph

2011-01-01

Objective Provide a detailed discussion of baseline health spending by state of residence (per capita personal health care spending, per enrollee Medicare spending, and per enrollee Medicaid spending) in 2009, over the last decade (1998–2009), as well as the differential regional and state impacts of the recent recession. Data Source State Health Expenditures by State of Residence for 1991–2009, produced by the Centers for Medicare & Medicaid Services' Office of the Actuary. Principal Findings In 2009, the 10 states where per capita spending was highest ranged from 13 to 36 percent higher than the national average, and the 10 states where per capita spending was lowest ranged from 8 to 26 percent below the national average. States with the highest per capita spending tended to have older populations and the highest per capita incomes; states with the lowest per capita spending tended to have younger populations, lower per capita incomes, and higher rates of uninsured. Over the last decade, the New England and Mideast regions exhibited the highest per capita personal health care spending, while states in the Southwest and Rocky Mountain regions had the lowest per capita spending. Variation in per enrollee Medicaid spending, however, has consistently been greater than that of total per capita personal health care spending or per enrollee Medicare spending from 1998–2009. The Great Lakes, New England, and Far West regions experienced the largest slowdown in per person health spending growth during the recent recession, largely as a result of higher unemployment rates. PMID:22340779

Public Education: Fingertip Facts 2005

ERIC Educational Resources Information Center

Harrington, Patti

2005-01-01

This paper offers facts and figures on Utah's state of education for 2005. This paper contains the following: (1) Education Contacts; (2) Utah State Board of Education members; (3) Value of Weighted Pupil Unit (WPU) for the 2004-05 school year; (4) Per Pupil Spending in Perspective (2002); (5) Public School Enrollment per district (October…

Environmental history impacts on gene expression during diapause development in Megachile rotundata

USDA-ARS?s Scientific Manuscript database

The alfalfa leafcutting bee is the primary pollinator used in the production of alfalfa seed in the United States and Canada. The alfalfa leafcutting bee spends approximately 9 months of the year in a dormancy state known as diapause, which makes this the primary stage managed by bee keepers. In ord...

Status of Teacher Performance Pay Programs across the United States. Information Capsule. Volume 1103

ERIC Educational Resources Information Center

Blazer, Christie

2011-01-01

An increasing number of states and school districts across the country are tying teacher pay to student performance. A recent RAND Education study found that nationwide spending on teacher performance pay increased from $99 million in 2006 to $439 million in 2010. However, many states and school districts face significant hurdles when they attempt…

Proposing an amendment to the Constitution of the United States to control spending.

THOMAS, 111th Congress

Rep. Hensarling, Jeb [R-TX-5

2010-03-03

House - 06/15/2010 Referred to the Subcommittee on the Constitution, Civil Rights, and Civil Liberties. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

Minding Ps and Qs: The Political and Policy Questions Framing Health Care Spending.

PubMed

Sage, William M

2016-12-01

Tracing the evolution of political conversations about health care spending and their relationship to the formation of policy is a valuable exercise. Health care spending is about science and ethics, markets and government, freedom and community. By the late 1980s the unique upward trajectory of post-Medicare U.S. health care spending had been established, recessions and tax cuts were eroding federal and state budgets, and efforts to harness market forces to serve policy goals were accelerating. From the initial writings on "managed competition," through the failed Clinton health reform effort in the early 1990s, to the passage of the Affordable Care Act in 2010, the policy narrative of health spending acquired a superficial consistency. On closer examination, however, it becomes apparent that the cost problem has been repeatedly reframed in political discourse even during this relatively brief period. The clearest transition has been from a narrative centered on rationing necessary care to one committed to reducing wasteful care - although the role of accumulated law and regulation in perpetuating waste remains largely unrecognized and the recently articulated commitment to population health seems an imperfect proxy for explicitly developing social solidarity with respect to health and health care in the United States.

The cost of cancer care: Part II.

PubMed

Eagle, David

2012-11-01

The rising cost of cancer treatment competes with the availability of effective therapy as a limiting factor in our war on cancer. Specific programs are being developed that have the potential to slow the growth in spending on oncology care. The Affordable Care Act includes provisions for containing healthcare costs, such as accountable care organizations and the Independent Payment Advisory Board. Within oncology, specific programs have emerged, including clinical pathways, episode-of-care based payment arrangements, and the oncology medical home. All models of cost containment have strengths and weaknesses. Outside of the United States, explicit rationing exists' through national health technology assessment organizations. Excessive demands on physicians to limit spending at the bedside could potentially create conflicts with their professional responsibility to patients. While spending for cancer care in the US is high, its "worth" is ultimately a societal decision. Recent economic modeling suggests that we may be achieving value for the money we spend.

Renewed Interest in Apprenticeship.

ERIC Educational Resources Information Center

Young, Darius R.; Gauss, Patricia A.

1994-01-01

Describes Alberta's registered apprenticeship plan (RAP), a three-year program in which students spend part of their time in school and part in industry as a registered apprenticeship. Compares RAP to the federal youth apprenticeship proposed in the United States and the European model. (JOW)

America's School Leftovers.

ERIC Educational Resources Information Center

Passmore, David L.

1991-01-01

Compared to other countries, the United States spends less for the transition from school to work of non-college-bound students. Costs of such training need to be viewed as an investment in productivity and competitiveness and in a better outlook for this forgotten group. (SK)

Higher Education Spending and the State Fiscal Stabilization Fund, Part 3: State Case Studies

ERIC Educational Resources Information Center

Cohen, Jennifer

2011-01-01

By late 2008, the United States was in the midst of its most severe economic recession since the 1930s, brought on by a collapse in real estate prices and exacerbated by the failure of many large banks and financial institutions. Heeding calls from economists, Congress and the Obama administration passed an historic law in early 2009 to stimulate…

Home and Community Based Services (HCBS) Waivers: A Nationwide Study of the States

ERIC Educational Resources Information Center

Rizzolo, Mary C.; Friedman, Carli; Lulinski-Norris, Amie; Braddock, David

2013-01-01

In fiscal year (FY) 2009, the Medicaid program funded over 75% of all publicly funded long-term supports and services (LTSS) for individuals with intellectual and developmental disabilities (IDD) in the United States (Braddock et al., 2011). The majority of spending was attributed to the Home and Community Based Services (HCBS) Waiver program. In…

Schoolhouses, Courthouses, and Statehouses: Solving the Funding-Achievement Puzzle in America's Public Schools

ERIC Educational Resources Information Center

Hanushek, Eric A.; Lindseth, Alfred A.

2009-01-01

Spurred by court rulings requiring states to increase public-school funding, the United States now spends more per student on K-12 education than almost any other country. Yet American students still achieve less than their foreign counterparts, their performance has been flat for decades, millions of them are failing, and poor and minority…

Public health spending in 2008: on the challenge of integrating PHSSR data sets and the need for harmonization.

PubMed

Leider, Jonathon P; Sellers, Katie; Shah, Gulzar; Pearsol, Jim; Jarris, Paul E

2012-01-01

In recent years, state and local public health department budgets have been cut, sometimes drastically. However, there is no systematic tracking of governmental public health spending that would allow researchers to assess these cuts in comparison with governmental public health spending as a whole. Furthermore, attempts to quantify the impact of public health spending are limited by the lack of good data on public health spending on state and local public health services combined. The objective of this article is to integrate self-reported state and local health department (LHD) survey data from 2 major national organizations to create state-level estimates of governmental public health spending. To create integrated estimates, we selected 1388 LHDs and 46 states that had reported requisite financial information. To account for the nonrespondent LHDs, estimates of the spending were developed by using appropriate statistical weights. Finally, funds from federal pass-through and state sources were estimated for LHDs and subtracted from the total spending by the state health agency to avoid counting these dollars in both state and local figures. On average, states spend $106 per capita on traditional public health at the state and local level, with an average of 42% of spending occurring at the local level. Considerable variation exists in state and local public health funding. The results of this analysis show a relatively low level of public health funding compared with state Medicaid spending and health care more broadly.

National health expenditures, 1989

PubMed Central

Lazenby, Helen C.; Letsch, Suzanne W.

1990-01-01

Spending for health care in the United States grew to $604.1 billion in 1989, an increase of 11.1 percent from the 1988 level. Growth in national health expenditures has been edging upward since 1986, when the annual growth in the health care bill was 7.7 percent. Health care spending continues to command a larger and larger proportion of the resources of the Nation: In 1989, 11.6 percent of the Nation's output, as measured by the gross national product, was consumed by health care, up from 11.2 percent in 1988. PMID:10113559

The Advertising Strategies of Early E-cigarette Brand Leaders in the United States

PubMed Central

Haardörfer, Regine; Cahn, Zachary; Lewis, Michael; Kothari, Shreya; Sarmah, Raina; Getachew, Betelihem; Berg, Carla J.

2017-01-01

Objectives We examined differential advertising strategies used by 4 major United States e-cigarette companies with differential affiliations with the traditional tobacco industry (ie, Njoy - independent, Blu – acquired, Vuse and MarkTen – launched by cigarette companies) over time. Methods We conducted a mixed-methods study regarding e-cigarette adspend, adspend per media channel (eg, TV, print), and advertising messaging strategies among these 4 top e-cigarette brands from January 2013 through December 2015. Results E-cigarette adspend increased from $59 million in 2013 to $91 million in 2014, followed by a sharp decline to $37 million in 2015. These companies showed distinct spending trajectories overall and across media channels, with Njoy and Vuse spending a higher proportion of their dollars on TV and Blu and MarkTen spending more on print. Marketing messages were also different by company. Key themes included switching from cigarettes (particularly by Njoy and Blu), circumventing smoke-free policies (particularly by Blu), and technological advancement (particularly by Vuse and MarkTen). Conclusions These e-cigarette brands have shifted their adspend, use of media channels, and advertising messaging strategies over time. Some differing strategies may reflect the different affiliations of each brand to the traditional cigarette industry. PMID:29392167

Health Spending By State 1991-2014: Measuring Per Capita Spending By Payers And Programs.

PubMed

Lassman, David; Sisko, Andrea M; Catlin, Aaron; Barron, Mary Carol; Benson, Joseph; Cuckler, Gigi A; Hartman, Micah; Martin, Anne B; Whittle, Lekha

2017-07-01

As the US health sector evolves and changes, it is informative to estimate and analyze health spending trends at the state level. These estimates, which provide information about consumption of health care by residents of a state, serve as a baseline for state and national-level policy discussions. This study examines per capita health spending by state of residence and per enrollee spending for the three largest payers (Medicare, Medicaid, and private health insurance) through 2014. Moreover, it discusses in detail the impacts of the Affordable Care Act implementation and the most recent economic recession and recovery on health spending at the state level. According to this analysis, these factors affected overall annual growth in state health spending and the payers and programs that paid for that care. They did not, however, substantially change state rankings based on per capita spending levels over the period. Project HOPE—The People-to-People Health Foundation, Inc.

The U.S. employment effects of military and domestic spending priorities.

PubMed

Pollin, Robert; Garrett-Peltier, Heidi

2009-01-01

This study focuses on the employment effects of military spending versus alternative domestic spending priorities. The authors begin by introducing the basic input-output modeling technique for considering issues such as these in a systematic way. They then present some simple alternative spending scenarios-namely, devoting $1 billion to the military versus the same amount of money spent for five alternatives: tax cuts that produce increased levels of personal consumption; health care; education; mass transit; and construction targeted at home weatherization and infrastructure repair. The first conclusion in assessing such relative employment effects is straightforward: $1 billion spent on personal consumption, health care, education, mass transit, and construction for home weatherization/infrastructure will all create more jobs in the U.S. economy than would the same $1 billion spent on the military. The authors then examine the pay level of jobs created through these alternative spending priorities and assess the overall welfare effects of the alternative employment outcomes. Combining these alternative domestic spending categories in an effective way can also generate a higher level of compensation for working people in the United States and a better average quality ofjobs.

Association of Reference Pricing with Drug Selection and Spending

PubMed Central

Robinson, James C.; Whaley, Christopher M.; Brown, Timothy T.

2017-01-01

BACKGROUND In the United States, prices for therapeutically similar drugs vary widely, which has prompted efforts by public and private insurers to steer patients toward the lower-priced options. Under reference pricing, the insurer or employer establishes a maximum contribution it will make toward the price of a drug or procedure, and the patient pays the remainder. METHODS We used difference-in-differences multivariable regression methods to analyze changes in prescriptions and pricing for 1302 drugs in 78 therapeutic classes in the United States, before and after implementation of reference pricing by an alliance of private employers. We assessed trends for the study group relative to those for an employee group that was not subject to reference pricing. The study included 1,122,741 prescriptions that were reimbursed during the period from 2010 through 2014. RESULTS Implementation of reference pricing was associated with a higher percentage of prescriptions that were filled for the lowest-priced reference drug within its therapeutic class (difference in probability, 7.0 percentage points; 95% confidence interval [CI], 4.0 to 9.9), a lower average price paid per prescription (−13.9%; 95% CI, −23.8 to −2.7), and a higher rate of copayment by patients (5.2%; 95% CI, 0.2 to 10.4) than in the comparison group. During the first 18 months after implementation, spending for employers was $1.34 million lower and the amount of copayments for employees was $0.12 million higher than in the comparison group. CONCLUSIONS Implementation of reference pricing was associated with significant changes in drug selection and spending for a population of patients covered by employment-based insurance in the United States. (Funded by the Agency for Healthcare Research and Quality and the Genentech Foundation.) PMID:28813219

Twelve years' experience with direct-to-consumer advertising of prescription drugs in Canada: a cautionary tale.

PubMed

Mintzes, Barbara; Morgan, Steve; Wright, James M

2009-05-27

Direct-to-consumer advertising (DTCA) of prescription drugs is illegal in Canada as a health protection measure, but is permitted in the United States. However, in 2000, Canadian policy was changed to allow 'reminder' advertising of prescription drugs. This is a form of advertising that states the brand name without health claims. 'Reminder' advertising is prohibited in the US for drugs that have 'black box' warnings of serious risks. This study examines spending on DTCA in Canada from 1995 to 2006, 12 years spanning this policy shift. We ask how annual per capita spending compares to that in the US, and whether drugs with Canadian or US regulatory safety warnings are advertised to the Canadian public in reminder advertising. Prescription drug advertising spending data were extracted from a data set on health sector spending in Canada obtained from a market research company, TNS Media Inc. Spending was adjusted for inflation and compared with US spending. Inflation-adjusted spending on branded DTCA in Canada grew from under CAD$2 million per year before 1999 to over $22 million in 2006. The major growth was in broadcast advertising, accounting for 83% of spending in 2006. US annual per capita spending was on average 24 times Canadian levels. Celebrex (celecoxib), which has a US black box and was subject to three safety advisories in Canada, was the most heavily advertised drug on Canadian television in 2005 and 2006. Of 8 brands with >$500,000 spending, which together accounted for 59% of branded DTCA in all media, 6 were subject to Canadian safety advisories, and 4 had US black box warnings. Branded 'reminder' advertising has grown rapidly in Canada since 2000, mainly due to a growth in television advertising. Although DTCA spending per capita is much lower in Canada than in the US, there is no evidence of safer content or product choice; many heavily-advertised drugs in Canada have been subject to safety advisories. For governments searching for compromise solutions to industry pressure for expanded advertising, Canada's experience stands as a stark warning.

Twelve Years' Experience with Direct-to-Consumer Advertising of Prescription Drugs in Canada: A Cautionary Tale

PubMed Central

Mintzes, Barbara; Morgan, Steve; Wright, James M.

2009-01-01

Background Direct-to-consumer advertising (DTCA) of prescription drugs is illegal in Canada as a health protection measure, but is permitted in the United States. However, in 2000, Canadian policy was changed to allow ‘reminder’ advertising of prescription drugs. This is a form of advertising that states the brand name without health claims. ‘Reminder’ advertising is prohibited in the US for drugs that have ‘black box’ warnings of serious risks. This study examines spending on DTCA in Canada from 1995 to 2006, 12 years spanning this policy shift. We ask how annual per capita spending compares to that in the US, and whether drugs with Canadian or US regulatory safety warnings are advertised to the Canadian public in reminder advertising. Methodology/Principal Findings Prescription drug advertising spending data were extracted from a data set on health sector spending in Canada obtained from a market research company, TNS Media Inc. Spending was adjusted for inflation and compared with US spending. Inflation-adjusted spending on branded DTCA in Canada grew from under CAD$2 million per year before 1999 to over $22 million in 2006. The major growth was in broadcast advertising, accounting for 83% of spending in 2006. US annual per capita spending was on average 24 times Canadian levels. Celebrex (celecoxib), which has a US black box and was subject to three safety advisories in Canada, was the most heavily advertised drug on Canadian television in 2005 and 2006. Of 8 brands with >$500,000 spending, which together accounted for 59% of branded DTCA in all media, 6 were subject to Canadian safety advisories, and 4 had US black box warnings. Conclusions/Significance Branded ‘reminder’ advertising has grown rapidly in Canada since 2000, mainly due to a growth in television advertising. Although DTCA spending per capita is much lower in Canada than in the US, there is no evidence of safer content or product choice; many heavily-advertised drugs in Canada have been subject to safety advisories. For governments searching for compromise solutions to industry pressure for expanded advertising, Canada's experience stands as a stark warning. PMID:19479084

The State Fiscal Stabilization Fund and Higher Education Spending in the States: Part 1 of 4. Issue Brief

ERIC Educational Resources Information Center

Cohen, Jennifer

2010-01-01

By late 2008, the United States was in the midst of its most severe economic recession since the 1930s, brought on by a collapse in real estate prices and exacerbated by the failure of many large banks and financial institutions. Heeding calls from economists, Congress and the Obama administration passed a historic law in early 2009 to stimulate…

An Approach to Forward Presence in a Resource-Constrained Environment

DTIC Science & Technology

2013-03-01

working quietly to coordinate cooperation between Indonesia, Malaysia , and Singapore , who were historically distrustful of each other. Through...freedom of action. Non-state actors will likely seek to capitalize on these weakening and corrupt failing states as potential safe havens. The low...11 Figure 1. 2011 Defense Spending: United States vs . 16 Next Leading Spenders44 Department of Defense can feel like it is hard pressed for

Refining estimates of public health spending as measured in national health expenditures accounts: the United States experience.

PubMed

Sensenig, Arthur L

2007-01-01

Providing for the delivery of public health services and understanding the funding mechanisms for these services are topics of great currency in the United States. In 2002, the Department of Homeland Security was created and the responsibility for providing public health services was realigned among federal agencies. State and local public health agencies are under increased financial pressures even as they shoulder more responsibilities as the vital first link in the provision of public health services. Recent events, such as hurricanes Katrina and Rita, served to highlight the need to accurately access the public health delivery system at all levels of government. The National Health Expenditure Accounts (NHEA), prepared by the National Health Statistics Group, measure expenditures on healthcare goods and services in the United States. Government public health activity constitutes an important service category in the NHEA. In the most recent set of estimates, Government Public Health Activity expenditures totaled $56.1 billion in 2004, or 3.0 percent of total US health spending. Accurately measuring expenditures for public health services in the United States presents many challenges. Among these challenges is the difficult task of defining what types of government activity constitute public health services. There is no clear-cut, universally accepted definition of government public health care services, and the definitions in the proposed International Classification for Health Accounts are difficult to apply to an individual country's unique delivery systems. Other challenges include the definitional issues associated with the boundaries of healthcare as well as the requirement that census and survey data collected from government(s) be compliant with the Classification of Functions of Government (COFOG), an internationally recognized classification system developed by the United Nations.

The Fiscal Effects of School Choice Programs on Public School Districts. National Research

ERIC Educational Resources Information Center

Scafidi, Benjamin

2012-01-01

In this report, the author constructs the first ever estimates for each state and the District of Columbia of the short-run fixed costs of educating children in public schools. He endeavors to make cautious overestimates of these short-run fixed costs. The United States' average spending per student was $12,450 in 2008-09. The author estimates…

Summary of the Spring Quarter 1971: Faculty Time Use Study at Humboldt State College.

ERIC Educational Resources Information Center

Lawson, Donald F.

Due to public misunderstanding of the unit-load measurement versus the hours per week standard of work measurement, a study was conducted at Humboldt State College to determine the average number of hours a full-time instructional faculty member spends in performing his job. Faculty activity data was collected by means of a daily-diary form of…

Changing of the Guard: Nation Building and the United States Military

DTIC Science & Technology

2010-06-01

under the constant threat of a nuclear exchange with its arch- rival. The resultant fear produced an abnormally influential defense establishment that...a threat previous administrations referenced to justify deficit spending for the purpose of maintaining an abnormally strong military during a time...more easily convinced to take on a broader range of missions. 71 Barlow describes the fractious state

Dollars and Sense: Analysis of Spending and Revenue Patterns to Inform Fiscal Planning for California Higher Education

ERIC Educational Resources Information Center

Shulock, Nancy; Offenstein, Jeremy; Esch, Camille

2011-01-01

After decades of focusing on expansion and access, California's institutions of higher education are now being handed a more difficult charge: to dramatically increase the number of college graduates with diminishing state funding. There is a growing consensus that the United States needs to ratchet up its production of college graduates to turn…

The Problem With Estimating Public Health Spending.

PubMed

Leider, Jonathon P

2016-01-01

Accurate information on how much the United States spends on public health is critical. These estimates affect planning efforts; reflect the value society places on the public health enterprise; and allows for the demonstration of cost-effectiveness of programs, policies, and services aimed at increasing population health. Yet, at present, there are a limited number of sources of systematic public health finance data. Each of these sources is collected in different ways, for different reasons, and so yields strikingly different results. This article aims to compare and contrast all 4 current national public health finance data sets, including data compiled by Trust for America's Health, the Association of State and Territorial Health Officials (ASTHO), the National Association of County and City Health Officials (NACCHO), and the Census, which underlie the oft-cited National Health Expenditure Account estimates of public health activity. In FY2008, ASTHO estimates that state health agencies spent $24 billion ($94 per capita on average, median $79), while the Census estimated all state governmental agencies including state health agencies spent $60 billion on public health ($200 per capita on average, median $166). Census public health data suggest that local governments spent an average of $87 per capita (median $57), whereas NACCHO estimates that reporting LHDs spent $64 per capita on average (median $36) in FY2008. We conclude that these estimates differ because the various organizations collect data using different means, data definitions, and inclusion/exclusion criteria--most notably around whether to include spending by all agencies versus a state/local health department, and whether behavioral health, disability, and some clinical care spending are included in estimates. Alongside deeper analysis of presently underutilized Census administrative data, we see harmonization efforts and the creation of a standardized expenditure reporting system as a way to meaningfully systematize reporting of public health spending and revenue.

CRITICAL ELEMENTS IN DESCRIBING AND UNDERSTANDING OUR NATION'S AQUATIC RESOURCES

EPA Science Inventory

Despite spending $115 billion per year on environmental actions in the United States, we have only a limited ability to describe the effectiveness of these expenditures. Moreover, after decades of such investments, we cannot accurately describe status and trends in the nation's a...

United States housing brief, August 2017

Treesearch

Delton Alderman

2018-01-01

The bright spot in September was new single-family sales, but housing starts appear to have stalled on a monthly basis. Regionally, data were mixed across all sectors. New construction spending’s contribution to U.S. gross domestic product decreased on a quarterly basis.

United States housing brief, September 2017

Treesearch

Delton Alderman

2018-01-01

The bright spot in September was new single-family sales, but housing starts appear to have stalled on a monthly basis. Regionally, data were mixed across all sectors. New construction spending’s contribution to U.S. gross domestic product decreased on a quarterly basis.

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.

The Mississippi State University College of Veterinary Medicine Shelter Program

PubMed Central

Bushby, Philip; Woodruff, Kimberly; Shivley, Jake

2015-01-01

Simple Summary First initiated in 1995 to provide veterinary students with spay/neuter experience, the shelter program at the Mississippi State University College of Veterinary Medicine has grown to be comprehensive in nature incorporating spay/neuter, basic wellness care, diagnostics, medical management, disease control, shelter management and biosecurity. Junior veterinary students spend five days in shelters; senior veterinary students spend 2-weeks visiting shelters in mobile veterinary units. The program has three primary components: spay/neuter, shelter medical days and Animals in Focus. Student gain significant hands-on experience and evaluations of the program by students are overwhelmingly positive. Abstract The shelter program at the Mississippi State University College of Veterinary Medicine provides veterinary students with extensive experience in shelter animal care including spay/neuter, basic wellness care, diagnostics, medical management, disease control, shelter management and biosecurity. Students spend five days at shelters in the junior year of the curriculum and two weeks working on mobile veterinary units in their senior year. The program helps meet accreditation standards of the American Veterinary Medical Association’s Council on Education that require students to have hands-on experience and is in keeping with recommendations from the North American Veterinary Medical Education Consortium. The program responds, in part, to the challenge from the Pew Study on Future Directions for Veterinary Medicine that argued that veterinary students do not graduate with the level of knowledge and skills that is commensurate with the number of years of professional education. PMID:26479234

Evolving reimbursement and pricing policies for devices in Europe and the United States should encourage greater value.

PubMed

Sorenson, Corinna; Drummond, Michael; Burns, Lawton R

2013-04-01

Rising health care costs are an international concern, particularly in the United States, where spending on health care outpaces that of other industrialized countries. Consequently, there is growing desire in the United States and Europe to take a more value-based approach to health care, particularly with respect to the adoption and use of new health technology. This article examines medical device reimbursement and pricing policies in the United States and Europe, with a particular focus on value. Compared to the United States, Europe more formally and consistently considers value to determine which technologies to cover and at what price, especially for complex, costly devices. Both the United States and Europe have introduced policies to provide temporary coverage and reimbursement for promising technologies while additional evidence of value is generated. But additional actions are needed in both the United States and Europe to ensure wise value-based reimbursement and pricing policies for all devices, including the generation of better pre- and postmarket evidence and the development of new methods to evaluate value and link evidence of value to reimbursement.

Health care spending accounts: a flexible solution for Canadian employers.

PubMed

Smithies, R; Steeves, L

1996-01-01

Flexible benefits plans have grown more slowly in Canada than in the United States, largely because of certain legal and regulatory considerations. Health care spending accounts (HCSAs) provide a cost-effective way for Canadian employers to address the health care benefit needs of a diverse workforce. A flexible health care spending account is a versatile and cost-effective instrument that can be used by Canadian employers that wish to provide a full range of health care benefits to employees. The health care alternatives available through an HCSA can provide employees with an opportunity to customize and optimize their benefits program. Regulatory requirements that an HCSA must meet in order to qualify for available tax advantages are discussed, as are the range of health care services that may be covered.

Variation in critical care services across North America and Western Europe.

PubMed

Wunsch, Hannah; Angus, Derek C; Harrison, David A; Collange, Olivier; Fowler, Robert; Hoste, Eric A J; de Keizer, Nicolette F; Kersten, Alexander; Linde-Zwirble, Walter T; Sandiumenge, Alberto; Rowan, Kathryn M

2008-10-01

Critical care represents a large percentage of healthcare spending in developed countries. Yet, little is known regarding international variation in critical care services. We sought to understand differences in critical care delivery by comparing data on the distribution of services in eight countries. Retrospective review of existing national administrative data. We identified sources of data in each country to provide information on acute care hospitals and beds, intensive care units and beds, intensive care admissions, and definitions of intensive care beds. Data were all referenced and from as close to 2005 as possible. United States, France, United Kingdom, Canada, Belgium, Germany, The Netherlands, and Spain. Not available. None. No standard definition existed for acute care hospital or intensive care unit beds across countries. Hospital beds varied three-fold from 221/100,000 population in the United States to 593/100,000 in Germany. Adult intensive care unit beds also ranged seven-fold from 3.3/100,000 population in the United Kingdom to 24.0/100,000 in Germany. Volume of intensive care unit admissions per year varied ten-fold from 216/100,000 population in the United Kingdom to 2353/100,000 in Germany. The ratio of intensive care unit beds to hospital beds was highly correlated across all countries except the United States (r = .90). There was minimal correlation between the number of intensive care unit beds per capita and health care spending per capita (r = .45), but high inverse correlation between intensive care unit beds and hospital mortality for intensive care unit patients across countries (r = -.82). Absolute critical care services vary dramatically between countries with wide differences in both numbers of beds and volume of admissions. The number of intensive care unit beds per capita is not strongly correlated with overall health expenditure, but does correlate strongly with mortality. These findings demonstrate the need for critical care data from all countries, as they are essential for interpretation of studies, and policy decisions regarding critical care services.

Summary of a conference on national health expenditures accounting

PubMed Central

Lindsey, Phoebe A.; Newhouse, Joseph P.

1986-01-01

The following summary is of a conference to review national health expenditures accounting. Attendees focused on the annual article published by the Health Care Financing Administration (HCFA) in the Health Care Financing Review that reports how much the United States spends on medical care. PMID:10311675

Canadian truckers could drive 14 hours at a stretch, under proposed new rule

DOT National Transportation Integrated Search

2000-01-15

Research shows the risk of crashing increases substantially if truck drivers spend more than eight hours behind the wheel. A new Canadian rule governing truckers' hours of service is due in June 2000. In contrast, truckers on United States roads are ...

78 FR 43227 - Proposed Collection, Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-19

... in the United States. It measures, for example, time spent with children, working, sleeping, or doing... their time vary across demographic and labor force characteristics, such as age, sex, race, ethnicity, employment status, earnings, and education? How much time do parents spend in the company of their children...

Prescription drug spending trends in the United States: looking beyond the turning point.

PubMed

Aitken, Murray; Berndt, Ernst R; Cutler, David M

2009-01-01

Annual growth in real prescription drug spending averaged 9.9 percent during 1997-2007 but has slowed since 2003, falling to 1.6 percent in 2007. More patent expirations, increased generic penetration, and reduced new product innovations have contributed to this turning point. We document trends and identify underlying components: declines in the role of blockbuster drugs, increased importance of biologics and vaccines relative to traditional pharmaceuticals, and a changing medication mix away from those prescribed principally by primary care physicians toward those mostly prescribed by specialists. We conclude with policy implications.

Are We too Dumb to Execute Our Own Doctrine : An Analysis of Professional Military Education, Talent Management, and their Ability to Meet the Intent of the Capstone Concept for Joint Operations

DTIC Science & Technology

2016-04-04

in 2016, the United States military finds itself in another interwar period, with many similarities to the interwar period between World War I (WWI...and World War II (WWII). At the end of WWI, the nation demobilized the armed forces with over three million service men returning to civilian life...its military spending, falling to fifth in the world in 1938, spending only 2% of its gross domestic product (GDP) on defense. The Army, in

Are We Too Dumb to Execute Our Own Doctrine : An Analysis of Professional Military Education, Talent Management, and Their Ability to Meet the Intent of The Capstone Concept for Joint Operations

DTIC Science & Technology

2016-04-04

in 2016, the United States military finds itself in another interwar period, with many similarities to the interwar period between World War I (WWI...and World War II (WWII). At the end of WWI, the nation demobilized the armed forces with over three million service men returning to civilian life...its military spending, falling to fifth in the world in 1938, spending only 2% of its gross domestic product (GDP) on defense. The Army, in

Private gain and public pain: financing American health care.

PubMed

Siegel, Bruce; Mead, Holly; Burke, Robert

2008-01-01

Health care spending comprises about 16% of the total United States gross domestic product and continues to rise. This article examines patterns of health care spending and the factors underlying their proportional growth. We examine the "usual suspects" most frequently cited as drivers of health care costs and explain why these may not be as important as they seem. We suggest that the drive for technological advancement, coupled with the entrepreneurial nature of the health care industry, has produced inherently inequitable and unsustainable health care expenditure and growth patterns. Successful health reform will need to address these factors and their consequences.

The State Fiscal Stabilization Fund and Higher Education Spending: Part 2 of 4

ERIC Educational Resources Information Center

Cohen, Jennifer S.

2011-01-01

By late 2008, the United States was in the midst of its most severe economic recession since the 1930s, brought on by a collapse in real estate prices and exacerbated by the failure of many large banks and financial institutions. Heeding calls from economists, Congress and the Obama administration passed a historic law in early 2009 to stimulate…

Prairie strips improve biodiversity and the delivery of multiple ecosystem services from corn-soybean croplands

USDA-ARS?s Scientific Manuscript database

Losses of biodiversity and ecosystem services from industrial agricultural lands are persistent and growing challenges in the United States despite decades of spending on natural resource management. Most investments have been targeted toward engineered practices (e.g., sediment control basins, terr...

Three Centuries of American Inequality.

ERIC Educational Resources Information Center

Lindert, Peter H.; Williamson, Jeffrey G.

Income inequality in the United States displays considerable variance since the seventeenth century. There is no eternal constancy to the degree of inequality in total income, in labor earnings, or in income from conventional nonhuman wealth either before or after the effects of government taxes and spending. When all the necessary adjustments to…

Balancing Education: Let's Hear It More for the Humanities.

ERIC Educational Resources Information Center

Wolf, Alvin

1995-01-01

The United States needs more citizens who question the morality of using military power to conduct foreign affairs and who can ethically weigh federal spending and industrial, environmental, and social priorities. Instead of bemoaning students' dismal math and science performance, we should address their woeful ignorance of history, literature,…

Materials for Children about Nuclear War.

ERIC Educational Resources Information Center

Eiss, Harry

President Reagan's Fiscal Year 1987 budget was an attempt to increase dramatically spending on national defense, on nuclear weapons, while cutting back on social programs. The increases for almost all nuclear weapons indicate the Administration of the United States saw its major responsibility as one of providing a strong military, one centered on…

Incidence and public health burden of sunburn among beachgoers in the United States

EPA Science Inventory

Sunburn, a preventable skin condition, is a major risk factor for skin cancer. Severe burns can result in emergency department visits and in some cases hospitalization. Many people spend hours in direct sunlight while at the beach, which could lead to sunburn. We pooled data fro...

Continuing Education Needs of Natural Resource Managers and Scientists.

ERIC Educational Resources Information Center

George, John L.; Dubin, Samuel S.

Five thousand natural resource managers and scientists throughout the United States were asked to indicate their current education needs. It was concluded that, merely to keep abreast, they should spend one day a week or the equivalent in regularly scheduled study. Training is needed in environmental management, interrelationships of the…

78 FR 50373 - Proposed Information Collection; Comment Request; Annual Capital Expenditures Survey

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-19

... source of detailed comprehensive statistics on actual business spending for non-farm companies, non- governmental companies, organizations, and associations operating in the United States. Both employer and nonemployer companies are included in the survey. The Bureau of Economic Analysis, the primary Federal user of...

RISK ASSESSMENT AND MANAGEMENT OF WATER SUPPLY SYSTEM - INFRASTRUCTURE INITIATIVE FOR THE 21ST CENTURY

EPA Science Inventory

The current problem in the United States is that the water infrastructure is aging and spending has not been adequate to repair, replace, or rehabilitate drinking water distribution systems and wastewater collection systems. The American Society of Civil Engineers Report Card in...

40 CFR 1612.1 - Purpose and scope.

Code of Federal Regulations, 2010 CFR

2010-07-01

... litigants; (4) Avoid spending the time and money of the United States for private purposes; and (5) To... requesting material for use in legal proceedings (including administrative proceedings) in which the Chemical Safety and Hazard Investigation Board (CSB) is not a party, and procedures to be followed by the employee...

49 CFR 837.1 - Purpose and scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... proceedings) in which the National Transportation Safety Board (NTSB or Board) is not a party, and procedures to be followed by the employee upon receipt of a subpoena, order, or other demand (collectively... impartiality of the Board among private litigants; (4) Avoid spending the time and money of the United States...

The Power of Student Empowerment: Measuring Classroom Predictors and Individual Indicators

ERIC Educational Resources Information Center

Kirk, Chris Michael; Lewis, Rhonda K.; Brown, Kyrah; Karibo, Brittany; Park, Elle

2016-01-01

Despite spending more money per student than almost all developed nations, the United States lags behind in educational indicators with persistent disparities between privileged and marginalized students. Most approaches have ignored the role of power dynamics in predicting student performance. Building on the existing literature in school climate…

Location Matters: Geographic Location and Educational Placement of Students with Developmental Disabilities

ERIC Educational Resources Information Center

Brock, Matthew E.; Schaefer, John M.

2015-01-01

Despite decades of advocacy, most students with developmental disabilities continue to spend the majority of the school day in self-contained special education classrooms. However, there is tremendous variability of educational placement across the United States. Identification of geographic trends that explain this variability could provide…

Now Hiring: The Faculty of the Future

ERIC Educational Resources Information Center

Green, Donald W.; Ciez-Volz, Kathleen

2010-01-01

Community colleges across the United States are experiencing an extraordinarily high demand for new instructors. Hiring exemplary instructors is at once an educational and an economic imperative, for the typical community college spends over $3 million on the career of one faculty member. Institutions must make sound, long-term decisions by…

Variation In Health Outcomes: The Role Of Spending On Social Services, Public Health, And Health Care, 2000-09.

PubMed

Bradley, Elizabeth H; Canavan, Maureen; Rogan, Erika; Talbert-Slagle, Kristina; Ndumele, Chima; Taylor, Lauren; Curry, Leslie A

2016-05-01

Although spending rates on health care and social services vary substantially across the states, little is known about the possible association between variation in state-level health outcomes and the allocation of state spending between health care and social services. To estimate that association, we used state-level repeated measures multivariable modeling for the period 2000-09, with region and time fixed effects adjusted for total spending and state demographic and economic characteristics and with one- and two-year lags. We found that states with a higher ratio of social to health spending (calculated as the sum of social service spending and public health spending divided by the sum of Medicare spending and Medicaid spending) had significantly better subsequent health outcomes for the following seven measures: adult obesity; asthma; mentally unhealthy days; days with activity limitations; and mortality rates for lung cancer, acute myocardial infarction, and type 2 diabetes. Our study suggests that broadening the debate beyond what should be spent on health care to include what should be invested in health-not only in health care but also in social services and public health-is warranted. Project HOPE—The People-to-People Health Foundation, Inc.

Incentive formularies and changes in prescription drug spending.

PubMed

Landon, Bruce E; Rosenthal, Meredith B; Normand, Sharon-Lise T; Spettell, Claire; Lessler, Adam; Underwood, Howard R; Newhouse, Joseph P

2007-06-01

To examine the impact of incentive formularies on prescription drug spending shifts in formulary compliance, use of generic medications, and mail-order fulfillment in the year after introduction of a new pharmacy benefit strategy. Pre-post comparison study with matched concurrent control group (difference-indifferences analysis). Study subjects were continuously enrolled patients from a single large health plan in the northeastern United States. Health plan administrative data were used to determine the total, health plan, and out-of-pocket spending in the year before and the year after the introduction of 12 different benefit changes, including 1 in which copayments decreased. Overall, changing from a single-tier or 2-tier formulary to a 3-tier formulary was associated with a decrease in total drug spending of about 5% to 15%. Plan spending decreased more dramatically, about 20%, whereas out-of-pocket spending that resulted from higher copayments increased between 20% and >100%. Changing to an incentive formulary with higher copayments was accompanied by a small but inconsistent decrease in use of nonformulary selections and a concomitant increase in both generic and formulary preferred utilization. Mail-order fulfillment doubled, albeit from a low baseline level. Switching to incentive formulary arrangements with higher levels of copayments generally led to overall lower drug costs and vice versa. These effects varied with the degree of change, level of baseline spending, and magnitude of the copayments. Whether these effects are beneficial overall depends on potential health effects and spillover effects on medical spending.

How Medicaid Expansion Affected Out-of-Pocket Health Care Spending for Low-Income Families.

PubMed

Glied, Sherry; Chakraborty, Ougni; Russo, Therese

2017-08-01

ISSUE. Prior research shows that low-income residents of states that expanded Medicaid under the Affordable Care Act are less likely to experience financial barriers to health care access, but the impact on out-of-pocket spending has not yet been measured. GOAL. Assess how the Medicaid expansion affected out-of-pocket health care spending for low-income families compared to those in states that did not expand and consider whether effects differed in states that expanded under conventional Medicaid rules vs. waiver programs. METHODS. Analysis of the Consumer Expenditure Survey 2010–2015. KEY FINDINGS AND CONCLUSIONS. Compared to families in nonexpansion states, low-income families in states that did expand Medicaid saved an average of $382 in annual spending on health care. In these states, low-income families were less like to report any out-of-pocket spending on insurance premiums or medical care than were similar families in nonexpansion states. For families that did have some out-of-pocket spending, spending levels were lower in states that expanded Medicaid. Low-income families in Medicaid expansion states were also much less likely to have catastrophically high spending levels. The form of coverage expansion — conventional Medicaid or waiver rules — did not have a statistically significant effect on these outcomes.

Healthcare technology: physician collaboration in reducing the surgical cost.

PubMed

Olson, Steven A; Obremskey, William T; Bozic, Kevin J

2013-06-01

The increasing cost of providing health care is a national concern. Healthcare spending related to providing hospital care is one of the primary drivers of healthcare spending in the United States. Adoption of advanced medical technologies accounts for the largest percentage of growth in healthcare spending in the United States when compared with other developed countries. Within the specialty of orthopaedic surgery, a variety of implants can result in similar outcomes for patients in several areas of clinical care. However, surgeons often do not know the cost of implants used in a specific procedure or how the use of an implant or technology affects the overall cost of the episode of care. The purposes of this study were (1) to describe physician-led processes for introduction of new surgical products and technologies; and (2) to inform physicians of potential cost savings of physician-led product contract negotiations and approval of new technology. We performed a detailed review of the steps taken by two centers that have implemented surgeon-led programs to demonstrate responsibility in technology acquisition and product procurement decision-making. Each program has developed a physician peer review process in technology and new product acquisition that has resulted in a substantial reduction in spending for the respective hospitals in regard to surgical implants. Implant costs have decreased between 3% and 38% using different negotiating strategies. At the same time, new product requests by physicians have been approved in greater than 90% of instances. Hospitals need physicians to be engaged and informed in discussions concerning current and new technology and products. Surgeons can provide leadership for these efforts to reduce the cost of high-quality care.

Association Between Availability of a Price Transparency Tool and Outpatient Spending.

PubMed

Desai, Sunita; Hatfield, Laura A; Hicks, Andrew L; Chernew, Michael E; Mehrotra, Ateev

2016-05-03

There is increasing interest in using price transparency tools to decrease health care spending. To measure the association between offering a health care price transparency tool and outpatient spending. Two large employers represented in multiple market areas across the United States offered an online health care price transparency tool to their employees. One introduced it on April 1, 2011, and the other on January 1, 2012. The tool provided users information about what they would pay out of pocket for services from different physicians, hospitals, or other clinical sites. Using a matched difference-in-differences design, outpatient spending among employees offered the tool (n=148,655) was compared with that among employees from other companies not offered the tool (n=295,983) in the year before and after it was introduced. Availability of a price transparency tool. Annual outpatient spending, outpatient out-of-pocket spending, use rates of the tool. Mean outpatient spending among employees offered the tool was $2021 in the year before the tool was introduced and $2233 in the year after. In comparison, among controls, mean outpatient spending changed from $1985 to $2138. After adjusting for demographic and health characteristics, being offered the tool was associated with a mean $59 (95% CI, $25-$93) increase in outpatient spending. Mean outpatient out-of-pocket spending among those offered the tool was $507 in the year before introduction of the tool and $555 in the year after. Among the comparison group, mean outpatient out-of-pocket spending changed from $490 to $520. Being offered the price transparency tool was associated with a mean $18 (95% CI, $12-$25) increase in out-of-pocket spending after adjusting for relevant factors. In the first 12 months, 10% of employees who were offered the tool used it at least once. Among employees at 2 large companies, offering a price transparency tool was not associated with lower health care spending. The tool was used by only a small percentage of eligible employees.

Selected Trends in Public Spending for MR/DD Services and the State Economies.

ERIC Educational Resources Information Center

Hemp, Richard; Rizzolo, Mary Catherine; Braddock, David

2002-01-01

This article summarizes mental retardation/developmental disabilities (MR/DD) spending since 1977, with emphasis on spending from 1995-2000. The change in state economic conditions, from strong growth in recent years to fiscal constraints in 2002, is addressed. Tables provide data trends in MR spending by type of placement and state and changes in…

Know how to maximize maintenance spending

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

Carrino, A.J.; Jones, R.B.; Platt, W.E.

Solomon has developed a methodology to determine a large optimum point where availability meets maintenance spending for Powder River Basin (PRB) coal-fired units. Using a database of sufficient size and composition across various operating ranges, Solomon generated an algorithm that predicts the relationship between maintenance spending and availability. Coupling this generalized algorithm with a unit-specific market-loss curve determines the optimum spending for a facility. The article presents the results of the analysis, how this methodology can be applied to develop optimum operating and financial targets for specific units and markets and a process to achieve those targets. It also describesmore » how this methodology can be used for other types of fossil-fired technologies and future enhancements to the analysis. 5 figs.« less

Iran’s Economic Conditions: U.S. Policy Issues

DTIC Science & Technology

2010-04-22

trade and financial isolation. Iran’s economy is highly dependent on the production and export of crude oil to finance government spending, and...January 2010, the Iranian parliament approved a subsidy reform plan that would cut government subsidies on fuel and other goods and services...a central focus of U.S. national security policy. The United States has designated the Iranian government as a state sponsor of terrorism. The

CTC Sentinel. Volume 8, Issue 2

DTIC Science & Technology

2015-02-01

and Antiquities Looting,” Chasing Aphrodite, No- vember 18, 2014; Sam Hardy, “Tax and Spend: Laissez - Faire Islamic State Capitalism for the Illicit...to boost the organization’s standing in the minds of its constituents, Hezbollah leadership is well aware of the organization’s military...at Hearing on ‘The Tuareg Revolt and the Mali Coup’,” United States House of Representatives, Committee on Foreign Af- fairs , June 29. 2012, p. 43

Proposing the "Doris 'Granny D' Haddock Amendment of 2010" to the Constitution of the United States regarding the authority of Congress and the States to regulate the spending and activities of corporations with regard to political campaigns and campaigns for election for public office.

THOMAS, 111th Congress

Rep. Hodes, Paul W. [D-NH-2

2010-04-14

House - 06/15/2010 Referred to the Subcommittee on the Constitution, Civil Rights, and Civil Liberties. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

Nonresearch Industry Payments to Radiologists: Characteristics and Associations With Regional Medical Imaging Utilization.

PubMed

Kokabi, Nima; Junn, Jacqueline C; Xing, Minzhi; Hemingway, Jennifer; Hughes, Danny R; Duszak, Richard

2017-03-01

To evaluate characteristics of nonresearch industry payments to radiologists and associations with regional diagnostic imaging utilization. Using 2014 CMS Open Payment data, all disclosed nonresearch-related industry payments to radiologists were identified. Health Resources and Services Administration Area Health Resources Files were used to identify actual and population-weighted numbers of radiologists by state. Utilizing the 5% random beneficiary sample CMS Research Identifiable Files from 2014, average Medicare imaging spending per beneficiary in each state was calculated. Average frequency and dollar amounts of nonresearch nonroyalty payments to radiologists were calculated at the state level. Using the Pearson correlation coefficient, the relationship between frequency and amounts of nonresearch payments to radiologists versus per-beneficiary Medicare imaging spending was evaluated at the state level. Overall, 2,008 radiologists (1,670 diagnostic, 338 interventional) received nonresearch nonroyalty payments from industry, representing 5.2% of all 38,857 radiologists nationwide. A total of 4,975 individual transfers translated to 2.5 ± 1.3 discrete payments per receiving radiologist with a mean of $432 ± $1,976 (median $26; range $1-$34,050). Food and beverage expenses constituted the vast majority of disclosed transfers (4,111; 83%), followed by travel and lodging (444; 9%), consulting fees (279; 6%), and educational expenses (51; 1%). Considerable geographic variation in payments was observed, ranging from 0% of radiologists in Vermont to 12.9% in the District of Columbia. No correlation was identified between average per-beneficiary Medicare imaging spending and the proportion of nonresearch-funded radiologists in each state (r = 0.06). Similarly, no correlation was identified between average per-beneficiary Medicare imaging spending and the average nonresearch transfer amount to radiologists in each state (r = -0.08). In 2014, only a small minority of United States radiologists received nonresearch payments from industry. At the state level, medical imaging utilization does not seem to be influenced by such financial relationships. Copyright © 2016. Published by Elsevier Inc.

Healthcare "just around the corner": the role of geographic distribution strategies and healthcare costs.

PubMed

Keegan, Deborah Walker

2010-01-01

Proponents of the healthcare reform agenda continually compare per capita healthcare spending in the United States to other nations and cite this as one of the clear mandates for healthcare reform. The purpose of this article is to draw attention to the cost of geographic distribution strategies adopted by healthcare organizations and the impact this has on per capita healthcare costs. It is important to quantify the cost of such strategies and to weigh their merits, if the intent is to substantially reduce the cost of healthcare in the United States.

Educating for International Interdependence: The Role of the Academic Library--Ohio University and Malaysia.

ERIC Educational Resources Information Center

Mulliner, K.; Lee, Hwa-Wei

There is a role, and even a responsibility, for academic libraries in the United States in cooperating with students, scholars, colleagues, institutions, and governments in Third World nations. For example, the international library internship program, in which professional librarians at the middle-management level spend three to six months…

Prairie strips improve biodiversity and the delivery of multiple ecosystem services from corn–soybean croplands

Treesearch

Lisa A. Schulte; Jarad Niemi; Matthew J. Helmers; Matt Liebman; J. Gordon Arbuckle; David E. James; Randall K. Kolka; Matthew E. O’Neal; Mark D. Tomer; John C. Tyndall; Heidi Asbjornsen; Pauline Drobney; Jeri Neal; Gary Van Ryswyk; Chris Witte

2017-01-01

Loss of biodiversity and degradation of ecosystem services from agricultural lands remain important challenges in the United States despite decades of spending on natural resource management. To date, conservation investment has emphasized engineering practices or vegetative strategies centered on monocultural plantings of nonnative plants, largely excluding native...

If Kids Could Vote: Children, Democracy, and the Media

ERIC Educational Resources Information Center

Sugarman, Sally

2006-01-01

Preparing children to become citizens of a democracy requires recognition of the different ways in which children learn about politics. Kids in the United States currently spend most of their lives in controlled situations such as schools where the dependency they experience in their homes is reinforced. Besides teachers--books, films, television,…

Statistical Handbook on Consumption and Wealth in the United States.

ERIC Educational Resources Information Center

Kaul, Chandrika, Ed.; Tomaselli-Moschovitis, Valerie, Ed.

This easy-to-use statistical handbook features the most up-to-date and comprehensive data related to U.S. wealth and consumer spending patterns. More than 300 statistical tables and charts are organized into 8 detailed sections. Intended for students, teachers, and general users, the handbook contains these sections: (1) "General Economic…

Blueprint for Tomorrow: Redesigning Schools for Student-Centered Learning

ERIC Educational Resources Information Center

Nair, Prakash

2014-01-01

The United States has about $2 trillion tied up in aging school facilities. School districts throughout the country spend about $12 billion every year keeping this infrastructure going. Yet almost all of the new money we pour into school facilities reinforces an existing--and obsolete--model of schooling. In "Blueprint for Tomorrow,"…

Cultural Pluralism and Global Interdependence: Teaching and Learning for the 21st Century.

ERIC Educational Resources Information Center

Nava, Julian

1988-01-01

Presented at the National Council for the Social Studies annual meeting in Dallas on November 16, 1987, this article discusses issues such as military spending, peaceful competition with other nations, and minority group affairs, which face the United States and its students as the year 2000 approaches. (GEA)

United States housing brief, November 2017

Treesearch

Delton Alderman

2018-01-01

November’s new single-family (SF) sales and SF housing starts were remarkable. Other housing data appear to have stalled on a monthly basis. Regionally, data were mixed across all sectors. New SF construction and remodeling spending remain relatively strong. Existing house sales improved on a month-over-month and year-over-year basis.

United States housing brief, December 2017

Treesearch

Delton Alderman

2018-01-01

Although the aggregate U.S. housing market was mixed in December, both new single-family (SF) sales and starts were revised substantially downward. Other housing data appear to have flat-lined on a month-over-month basis. Regionally, data were mixed across all sectors. New SF construction and remodeling spending remain positive, increasing at an incremental pace.

Spending Money when It Is Not Clear What Works

ERIC Educational Resources Information Center

Hill, Paul T.

2008-01-01

Public school funding in the United States is not a product of intelligent design. Funding programs have grown willy-nilly based on political entrepreneurship, interest group pressure, and intergovernmental competition. Consequently, now that Americans feel the need to educate all children to high standards, no one knows for sure how money is used…

A Qualitative Study of Social Barriers to Digitizing Medical Records

ERIC Educational Resources Information Center

Belcher, Kenneth L., II

2012-01-01

The cost of the American healthcare system has escalated to the point that the United States spends more per patient than any other country. Based on the cost controls and increase in efficiency seen in other industries, many agree that information technology solutions should be adopted by the American healthcare industry. However, healthcare…

Childhood Obesity: A Growing Phenomenon for Physical Educators

ERIC Educational Resources Information Center

Green, Gregory; Reese, Shirley A.

2006-01-01

The greatest health risk facing children today is obesity. The prevalence of childhood obesity in the United States has risen dramatically in the past several decades. Because children on the average spend up to five or six hours a day involved in sedentary activities, including excessive time watching television, using the computer and playing…

A Strengths-Based Approach to Supervised Visitation in Child Welfare

ERIC Educational Resources Information Center

Smith, Gabriel Tobin; Shapiro, Valerie B.; Sperry, Rachel Wagner; LeBuffe, Paul A.

2014-01-01

This article describes a strengths-based approach to supervised visitation within the child welfare system of the United States. Supervised visitation gives parents accused of abuse or neglect the opportunity to spend time with children temporarily removed from their care. Although supervised visitation has the potential to be a tool for promoting…

Banning the Bottle

ERIC Educational Resources Information Center

Palliser, Janna

2010-01-01

Bottled water is ubiquitous, taken for granted, and seemingly benign. Americans are consuming bottled water in massive amounts and spending a lot of money: In 2007, Americans spent $11.7 billion on 8.8 billions gallons of bottled water (Gashler 2008). That same year, two million plastic water bottles were used in the United States every five…

Straight A's: Public Education Policy and Progress. Volume 6, Number 16

ERIC Educational Resources Information Center

Amos, Jason, Ed.

2006-01-01

"Straight A's: Public Education Policy and Progress" is a biweekly newsletter that focuses on education news and events both in Washington, DC and around the country. The following articles are included in this issue: (1) Paying Double: United States Spends Over $1.4 Billion Annually on Remedial Education for Recent High School…

How Do Cohabiting Couples with Children Spend Their Money?

ERIC Educational Resources Information Center

Deleire, Thomas; Kalil, Ariel

2005-01-01

Increasing rates of cohabitation in the United States raise important questions about how cohabitation fits in with the definition of family. Answers to this question depend in part upon the extent to which cohabitors behavior differs from that of other family types. Using data from the Consumer Expenditure Survey, we compare the expenditure…

How Do Cohabiting Couples with Children Spend Their Money? JCPR Working Paper.

ERIC Educational Resources Information Center

DeLeire, Thomas; Kalil, Ariel

Cohabitation is an increasingly prevalent living arrangement in the United States. Although the effects of living in a cohabiting arrangement on child wellbeing are not fully understood, the literature on children growing up in cohabiting families suggests that they have poorer developmental outcomes than do those growing up in married-parent…

The Economic Effects of the President’s 2015 Budget

DTIC Science & Technology

2014-07-01

CONGRESS OF THE UNITED STATES CONGRESSIONAL BUDGET OFFICE CBO The Economic Effects of the President’s 2015 Budget JULY 2014 © S hu tte rs to ck...from other proposals: cuts in spending for overseas military operations, reductions in Medicare’s net payments, and tax increases for people with high

eProcurement: The Technology of Smart Shopping

ERIC Educational Resources Information Center

Briggs, Linda L.

2006-01-01

This article talks about eProcurement and examines why school districts are so slow to make the transition. Despite the billions of dollars that flow from schools each year in procurement spending, most K-12 districts in the United States, especially smaller ones, persist in using paperbased procurement models in which supplies are identified in…

Interdependent Group Contingency to Promote Physical Activity in Children

ERIC Educational Resources Information Center

Foote, Catherine; Bray, Melissa A.; Kehle, Thomas J.; VanHeest, Jaci L.; Gelbar, Nicholas W.; Byer-Alcorace, Gabriel; Maykel, Cheryl; DeBiase, Emily

2017-01-01

As the number of children affected by obesity increases in the United States, it is necessary to intervene with preventive and intervention techniques that will enact change. Because children spend a significant amount of their time in school, it is of particular interest to target strategies during the school day. Given the recommendations for…

We the Peoples: When American Education Began

ERIC Educational Resources Information Center

Warren, Donald

2007-01-01

"The accomplishments of Indians and their actual place in the story of the United States have never been remotely touched by ... [most] historians. The major reason for this omission is that a substantial number of practicing historians simply do not know the source documents with sufficient precision to make sense of them; ... They spend a…

Culture as Catalyst and Constraint.

ERIC Educational Resources Information Center

Martin, Bruce K.

A disturbing gulf between the culture of the United States and that of Singapore, was noted by an American English professor after spending the 1986-87 academic year as a Fullbright lecturer in Singapore's Department of English and Literature and again after returning for the 1991-92 academic year as a visiting professor. Cultural differences were…

US Research on Wildland Fires??…with a Focus on EPA’s Efforts

EPA Science Inventory

The United States spends more than $1 billion every year to fight wildfires. According to National Interagency Fire Center data, of the 10 years with the largest acreage burned, nine have occurred since 2000 (as of 2012). This period coincides with many of the warmest years on re...

Time for School?

ERIC Educational Resources Information Center

Marcotte, Dave E.; Hansen, Benjamin

2010-01-01

Students in the United States spend much less time in school than do students in most other industrialized nations, and the school year has been essentially unchanged for more than a century. This is not to say that there is no interest in extending the school year. While there has been little solid evidence that doing so will improve learning…

Fishing--A Sport for All Seasons

ERIC Educational Resources Information Center

McIntosh, Phyllis

2011-01-01

In the United States, the phrase "goin' fishin'" is synonymous with taking a break and leaving everyday cares behind to go enjoy the outdoors, spend time with family or friends, and, if one is lucky, catch some tasty fish. According to the American Sportfishing Association, fishing is a hobby pursued by some 40 million Americans,…

Redesigning Continuing Education in the Health Professions

ERIC Educational Resources Information Center

National Academies Press, 2010

2010-01-01

Today in the United States, the professional health workforce is not consistently prepared to provide high quality health care and assure patient safety, even as the nation spends more per capita on health care than any other country. The absence of a comprehensive and well-integrated system of continuing education (CE) in the health professions…

The War against America's Public Schools: Privatizing Schools, Commercializing Education.

ERIC Educational Resources Information Center

Bracey, Gerald W.

Education reform has a long and ignoble history of searching for magic bullets. Charter schools, vouchers, educational management organizations, tuition tax credits, and high-standards movements are all part of the education landscape today. Some reformers are mere opportunists who look at the $700 billion that the United States spends on…

State Spending on Higher Education Capital Outlays

ERIC Educational Resources Information Center

Delaney, Jennifer A.; Doyle, William R.

2014-01-01

This paper explores the role that state spending on higher education capital outlays plays in state budgets by considering the functional form of the relationship between state spending on higher education capital outlays and four types of state expenditures. Three possible functional forms are tested: a linear model, a quadratic model, and the…

Trends in cost sharing among selected high income countries--2000-2010.

PubMed

Hossein, Zare; Gerard, Anderson

2013-09-01

Many high income countries increased their level of patient cost sharing between 2000 and 2010 as one component of their policy agenda to reduce the level of health care spending. We use data from the OECD, European Observatory, and country-specific resources to analyze trends in the UK, Germany, Japan, France, and the United States. Some forms of cost sharing-deductibles, co-insurance, or co-payments-increased in all these countries, with the highest rates of increase occurring in the pharmaceutical sector. In spite of higher levels of cost-sharing, out-of-pocket spending as a percentage of total spending remained unchanged in most of these countries because they instituted programs to protect certain categories of individuals by creating out-of-pocket limits, exempting people with certain chronic diseases, or eliminating cost sharing for certain demographic groups and low-income people. Copyright © 2013 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

A Medicare primer.

PubMed

Satiani, Bhagwan

2009-08-01

Medicare is a massive and essential safety healthcare net for the elderly in the United States. It covers 45 million people in 2009 (almost one-sixth of the population) and projected to cover an increasing number of aged beneficiaries with a decreasing number of workers paying into the system. Medicare spending is about 13% of the federal budget and 3.2% of gross domestic product. A 7.4% annual growth rate in spending is expected to lead to potential insolvency by 2019. Spending on physician services and other suppliers is about 20% of Medicare outlays. Payment updates for physician services are insufficient in relation to the cost of providing services. The most serious issue remains a permanent fix for the sustained growth rate formula used for calculating payment updates for physicians. Further procrastination of difficult but essential decisions on funding has dire implications for Vascular Surgery and the patients we serve.

Reflections on measuring recreation and travel spending.

Treesearch

Daniel J. Stynes; Eric M. White

2006-01-01

This article reviews problems encountered in using visitor surveys to measure travel spending. Lack of consistency in question wording, spending categories, and units of analysis makes it difficult to compare results across studies. Spending results can be quite sensitive to a number of data-handling issues, in particular, the treatment of outliers, contaminants, and...

Workforce Investment Act: Interim Report on Status of Spending and States' Available Funds. Report to Congressional Requesters.

ERIC Educational Resources Information Center

Nilsen, Sigurd R.

A study assessed whether the Department of Labor's (DOL's) information on states' Workforce Investment Act of 1998 (WIA) spending was a true reflection of states' available funds. The most recent available spending data from DOL and the 50 states were analyzed. Interviews were conducted with state workforce officials in nine states, local…

New Rule on Spending by States Lacks Teeth

ERIC Educational Resources Information Center

Kelderman, Eric

2009-01-01

A new federal requirement that states provide consistent spending for higher education may not yet have much effect. As state budgets sour and colleges brace for cuts, only one state seems likely to have run afoul of the new rules this year, according to a "Chronicle" analysis of available data on state higher-education spending. Under…

Analyzing whether countries are equally efficient at improving longevity for men and women.

PubMed

Barthold, Douglas; Nandi, Arijit; Mendoza Rodríguez, José M; Heymann, Jody

2014-11-01

We examined the efficiency of country-specific health care spending in improving life expectancies for men and women. We estimated efficiencies of health care spending for 27 Organisation for Economic Co-operation and Development (OECD) countries during the period 1991 to 2007 using multivariable regression models, including country fixed-effects and controlling for time-varying levels of national social expenditures, economic development, and health behaviors. Findings indicated robust differences in health-spending efficiency. A 1% annual increase in health expenditures was associated with percent changes in life expectancy ranging from 0.020 in the United States (95% confidence interval [CI] = 0.008, 0.032) to 0.121 in Germany (95% CI = 0.099, 0.143). Health-spending increases were associated with greater life expectancy improvements for men than for women in nearly every OECD country. This is the first study to our knowledge to estimate the effect of country-specific health expenditures on life expectancies of men and women. Future work understanding the determinants of these differences has the potential to improve the overall efficiency and equity of national health systems.

United States biodefense, international law, and the problem of intent.

PubMed

Enemark, Christian

2005-01-01

Since the anthrax attacks of 2001 in the United States, annual U.S. government spending on biodefense programs has increased enormously. U.S. biodefense was once exclusively the domain of military agencies and was aimed principally at protecting battlefield troops against the products of state-run biological warfare programs. Today, it is engaged in and promoted by a variety of government agencies contemplating "bioterrorism," and it is aimed principally at protecting the American civilian population. I ask if certain U.S. biodefense policies, pointedly those funding "threat assessment" projects, make biological attacks paradoxically more likely by undermining international and transnational norms against deliberately causing disease. I conclude that they do and consider the ramifications of this answer.

JPRS Report, Near East & South Asia

DTIC Science & Technology

1989-03-03

Secretary Gives Views on Present Situation [AL-ANWAR 1 Jan] 27 QATAR Methods To Develop Water Resources Discussed [AL-RAYAH 25 Dec] 31 SAUDI ARABIA...Arabia, Kuwait, Qatar , the United Arab Emirates, Oman and Bahrain. GCC states are now spending $3 billion on reserve electricity and this project will...Arabia, Kuwait, Bahrain and Qatar ) will be connected by a power grid while the second stage will see the southern states of Oman and the UAE being

Lean and Green Hand Surgery.

PubMed

Van Demark, Robert E; Smith, Vanessa J S; Fiegen, Anthony

2018-02-01

Health care in the United States is both expensive and wasteful. The cost of health care in the United States continues to increase every year. Health care spending for 2016 is estimated at $3.35 trillion. Per capita spending ($10,345 per person) is more than twice the average of other developed countries. The United States also leads the world in solid waste production (624,700 metric tons of waste in 2011). The health care industry is second only to the food industry in annual waste production. Each year, health care facilities in the United States produce 4 billion pounds of waste (660 tons per day), with as much as 70%, or around 2.8 billion pounds, produced directly by operating rooms. Waste disposal also accounts for up to 20% of a hospital's annual environmental services budget. Since 1992, waste production by hospitals has increased annually by a rate of at least 15%, due in part to the increased usage of disposables. Reduction in operating room waste would decrease both health care costs and potential environmental hazards. In 2015, the American Association for Hand Surgery along with the American Society for Surgery of the Hand, American Society for Peripheral Nerve Surgery, and the American Society of Reconstructive Microsurgery began the "Lean and Green" surgery project to reduce the amount of waste generated by hand surgery. We recently began our own "Lean and Green" project in our institution. Using "minor field sterility" surgical principles and Wide Awake Local Anesthesia No Tourniquet (WALANT), both surgical costs and surgical waste were decreased while maintaining patient safety and satisfaction. As the current reimbursement model changes from quantity to quality, "Lean and Green" surgery will play a role in the future health care system. Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Differences in the volume of services and in prices drive big variations in Medicaid spending among US states and regions.

PubMed

Gilmer, Todd P; Kronick, Richard G

2011-07-01

It is well known that Medicaid spending per beneficiary varies widely across states. However, less is known about the cause of this variation, or about whether increased spending is associated with better outcomes. In this article we describe and analyze sources of interstate variation in Medicaid spending over several years. We find substantial variations both in the volume of services and in prices. Overall, per capita spending in the ten highest-spending states was $1,650 above the average national per capita spending, of which $1,186, or 72 percent, was due to the volume of services delivered. Spending in the ten lowest-spending states was $1,161 below the national average, of which $672, or 58 percent, was due to volume. In the mid-Atlantic region, increased price and volume resulted in the most expensive care among regions, whereas reduced price and volume in the South Central region resulted in the least expensive care among regions. Understanding these variations in greater detail should help improve the quality and efficiency of care-a task that will become more important as Medicaid is greatly expanded under the Affordable Care Act of 2010.

Bingo! Let's Learn about Energy

ERIC Educational Resources Information Center

Derby, Melanie; DeCesare, Carl

2011-01-01

An understanding of energy is critical to today's students, as energy-related spending in the United States tops 500 billion dollars per year (U.S. Department of Energy, 2010). Often, students do not consider where something as common as electricity comes from in order to charge an MP3 player or power a microwave. Students can realize real-world…

Views of News in the Middle East.

ERIC Educational Resources Information Center

Leidman, Mary Beth

In 1992, a communications researcher had the opportunity to spend seven months as a visiting professor at the University of Haifa in Israel. From the standpoint of an observer of media coverage, the timing and location of her stay was fortuitous. Israelis were conducting an election off schedule, and at the same time the United States was…

Teaching about Saving and Investing in the Elementary and Middle School Grades

ERIC Educational Resources Information Center

Suiter, Mary; Meszaros, Bonnie T.

2005-01-01

For several years, advocacy groups have recognized the need to strengthen financial education in the K-12 schools. Current statistics support their concerns. Financial illiteracy in the United States is astoundingly high. From 1992 to 2000, disposable personal income for Americans rose by 47 percent, but personal spending rose by 61 percent. In…

Sex, Sexuality, Sexting, and SexEd: Adolescents and the Media

ERIC Educational Resources Information Center

Brown, Jane D.; Keller, Sarah; Stern, Susannah

2009-01-01

The traditional media (television, radio, movies, magazines) and new, digital media (the Internet, Social Networking Sites such as Facebook and Myspace, and cell phones) have become important sex educators for adolescents. Adolescents in the United States spend six to seven hours a day with some form of media, often using more than one kind…

It All Adds Up: Examining and Enhancing Campus Climate for Affordability at a Four-Year University

ERIC Educational Resources Information Center

McClure, Kevin R.; Ryder, Andrew J.; Mauk, Andrew J.

2017-01-01

This study examined undergraduate students' perceptions of non-academic spending in college and how they navigated these expenses. Using a mixed-methods study at a public comprehensive university in the southeastern United States, we conceptualized these perceptions as a central component of campus climate for affordability in college. Findings…

6 CFR 5.48 - Considerations in determining whether the Department will comply with a demand or request

Code of Federal Regulations, 2010 CFR

2010-01-01

... 6 Domestic Security 1 2010-01-01 2010-01-01 false Considerations in determining whether the... need to avoid spending the time and money of the United States for private purposes; (6) The need to... the Executive Branch; or (6) Compliance would potentially impede or prejudice an on-going law...

The Role of School Health Services in Addressing the Needs of Students with Chronic Health Conditions: A Systematic Review

ERIC Educational Resources Information Center

Leroy, Zanie C.; Wallin, Robin; Lee, Sarah

2017-01-01

Children and adolescents in the United States spend many hours in school. Students with chronic health conditions (CHCs) may face lower academic achievement, increased disability, fewer job opportunities, and limited community interactions as they enter adulthood. School health services provide safe and effective management of CHCs, often for…

Incorporating High Value Care into Undergraduate Medical Education

ERIC Educational Resources Information Center

Faber, Erik; Wells, Daniel

2017-01-01

Identified Need: The United States spends the most per capita on healthcare, but ranks much lower than most industrialized nations in quality and many health metrics. Studies have shown higher costs do not translate to high quality care, and may indeed translate to lower quality care and patient experience. Teaching high value care (HVC) is only…

Cost Spreading in College Athletic Spending in the United States: Estimates and Implications

ERIC Educational Resources Information Center

Lipford, Jody W.; Slice, Jerry K.

2017-01-01

With rising costs, mounting student debt, and many schools experiencing financial hardship, the higher education industry faces unwanted scrutiny from the popular media and political sector. College athletics too have come under close examination because of rising costs and internal subsidies. In this paper, we provide estimates of the per-student…

Re-Imagining Language, Culture, and Family in Foster Care

ERIC Educational Resources Information Center

Puig, Victoria I.

2013-01-01

Nearly half a million children in the United States are currently being served by the foster care system. Infants and toddlers represent the largest single group entering foster care. While these very young children are at the greatest peril for physical, mental health, and developmental issues and tend to spend the longest time in the foster care…

New Ribbon for the Department of Education Spotlights Facilities

ERIC Educational Resources Information Center

Falken, Andrea Suarez

2012-01-01

In recent years, schools have been forced by rising costs and shrinking budgets to stretch their resources further than ever before in order to meet the educational needs of today's students. Energy costs continue to rise, placing unprecedented stress on limited funds. In fact, K-12 schools in the United States spend more than $8 billion every…

The Academic Gap: An International Comparison of the Time Allocation of Academically Talented Students

ERIC Educational Resources Information Center

Makel, Matthew C.; Wai, Jonathan; Putallaz, Martha; Malone, Patrick S.

2015-01-01

Despite growing concern about the need to develop talent across the globe, relatively little empirical research has examined how students develop their academic talents. Toward this end, the current study explored how academically talented students from the United States and India spend their time both in and out of school. Indian students…

Million Dollar Busing: Saving Money through Privatization

ERIC Educational Resources Information Center

Crates, Cheryl

2009-01-01

The economic crisis has had--and will continue to have--a dramatic effect on tax revenue and education spending throughout the United States and beyond. Yet children still show up for school every day in need of an education. In times like these, educators and school business managers must be as committed as ever to providing it. The economic…

The Lender’s Mercy

DTIC Science & Technology

2012-04-01

to utilize government spending in an attempt to stabilize banks , individuals, and corporations . Unfortunately, even before the crisis, government...DISTRIBUTION A. Approved for public release: Distribution unlimited Disclaimer The views expressed in this academic research paper are...as the world’s largest debtor, the United States, is positioning itself in a similarly precarious position. This paper seeks to explore how the

Early Care and Education as Educational Panacea: What Do We Really Know about Its Effectiveness?

ERIC Educational Resources Information Center

Lowenstein, Amy E.

2011-01-01

Most young children in the United States regularly spend time in early care and education (ECE) settings. Institutionalized messages surrounding ECE claim that it has the potential to promote children's life-long success, especially among low-income children. I examine the legitimacy of these claims by reviewing empirical evidence that bears on…

Hospital Schools in the United States. Bulletin, 1938, No. 17

ERIC Educational Resources Information Center

Matheison, Clele Lee

1939-01-01

Among the exceptional children for whom special educational facilities are essential are those who must spend weeks or months or years in a hospital or a sanatorium. Many of these children, while undergoing physical treatment, can very profitably engage in school work. Comparatively little has been written about this phase of educational activity,…

Supporting Students' College Success: The Role of Assessment of Intrapersonal and Interpersonal Competencies

ERIC Educational Resources Information Center

Herman, Joan, Ed.; Hilton, Margaret, Ed.

2017-01-01

The importance of higher education has never been clearer. Educational attainment--the number of years a person spends in school--strongly predicts adult earnings, as well as health and civic engagement. Yet relative to other developed nations, educational attainment in the United States is lagging, with young Americans who heretofore led the…

Research Universities and the American Recovery and Reinvestment Act: Competition, Resource Concentration, and the "Great Recession" in the United States

ERIC Educational Resources Information Center

Taylor, Barrett J.; Cantwell, Brendan

2016-01-01

This paper conceptualizes the U.S. federal government's response to the "Great Recession" as a "natural experiment" whose broad emphasis on counter-cyclical spending contrasts with the tendency towards stratification within the quasi-market for academic research support. Regression results indicate that resources tended to flow…

The Hub and the Spokes: Foundations, Intermediary Organizations, Incentivist Reforms, and the Politics of Research Evidence

ERIC Educational Resources Information Center

Scott, Janelle; Jabbar, Huriya

2014-01-01

The rise in the influence of and spending by educational philanthropists and foundations over the past two decades, especially in the area of market-based reforms, such as charter schools, vouchers, and merit pay, is evident across the United States. Largely due to philanthropic investments, relatively new educational intermediary organizations…

Improving the Nutritional Quality of the Lunches of Elementary School Children

ERIC Educational Resources Information Center

Farris, Alisha R.

2015-01-01

Over 50 million children attend public elementary and secondary schools in the United States each day. Children spend a substantial portion of their waking hours in school and consume one-third to one-half of their daily calories there, making schools a promising site to influence dietary quality and potentially the risk of childhood obesity.…

Educational Morality: A Task of Resisting the Economic Corruption of Academic Excellence.

ERIC Educational Resources Information Center

Van Allen, George H.

Although the United States leads the world in spending for education, the quality of education is under attack from all quarters. On college campuses, the perceived necessity to maintain enrollment levels, and a post-60's reluctance to be selective in admissions contributed to waning academic standards. Economic interests have become the dominant…

Current and future funding sources for specialty mental health and substance abuse treatment providers.

PubMed

Levit, Katharine R; Stranges, Elizabeth; Coffey, Rosanna M; Kassed, Cheryl; Mark, Tami L; Buck, Jeffrey A; Vandivort-Warren, Rita

2013-06-01

Goals were to describe funding for specialty behavioral health providers in 1986 and 2005 and examine how the recession, parity law, and Affordable Care Act (ACA) may affect future funding. Numerous public data sets and actuarial methods were used to estimate spending for services from specialty behavioral health providers (general hospital specialty units; specialty hospitals; psychiatrists; other behavioral health professionals; and specialty mental health and substance abuse treatment centers). Between 1986 and 2005, hospitals-which had received the largest share of behavioral health spending-declined in importance, and spending shares trended away from specialty hospitals that were largely funded by state and local governments. Hospitals' share of funding from private insurance decreased from 25% in 1986 to 12% in 2005, and the Medicaid share increased from 11% to 23%. Office-based specialty providers continued to be largely dependent on private insurance and out-of-pocket payments, with psychiatrists receiving increased Medicaid funding. Specialty centers received increased funding shares from Medicaid (from 11% to 29%), and shares from other state and local government sources fell (from 64% to 46%). With ACA's full implementation, spending on behavioral health will likely increase under private insurance and Medicaid. Parity in private plans will also push a larger share of payments for office-based professionals from out-of-pocket payments to private insurance. As ACA provides insurance for formerly uninsured individuals, funding by state behavioral health authorities of center-based treatment will likely refocus on recovery and support services. Federal Medicaid rules will increase in importance as more people needing behavioral health treatment become covered.

Locomotive Emission and Engine Idle Reduction Technology Demonstration Project

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

John R. Archer

2005-03-14

In response to a United States Department of Energy (DOE) solicitation, the Maryland Energy Administration (MEA), in partnership with CSX Transportation, Inc. (CSXT), submitted a proposal to DOE to support the demonstration of Auxiliary Power Unit (APU) technology on fifty-six CSXT locomotives. The project purpose was to demonstrate the idle fuel savings, the Nitrous Oxide (NOX) emissions reduction and the noise reduction capabilities of the APU. Fifty-six CSXT Baltimore Division locomotives were equipped with APUs, Engine Run Managers (ERM) and communications equipment to permit GPS tracking and data collection from the locomotives. Throughout the report there is mention of themore » percent time spent in the State of Maryland. The fifty-six locomotives spent most of their time inside the borders of Maryland and some spent all their time inside the state borders. Usually when a locomotive traveled beyond the Maryland State border it was into an adjoining state. They were divided into four groups according to assignment: (1) Power Unit/Switcher Mate units, (2) Remote Control units, (3) SD50 Pusher units and (4) Other units. The primary data of interest were idle data plus the status of the locomotive--stationary or moving. Also collected were main engine off, idling or working. Idle data were collected by county location, by locomotive status (stationary or moving) and type of idle (Idle 1, main engine idling, APU off; Idle 2, main engine off, APU on; Idle 3, main engine off, APU off; Idle 4, main engine idle, APU on). Desirable main engine idle states are main engine off and APU off or main engine off and APU on. Measuring the time the main engine spends in these desirable states versus the total time it could spend in an engine idling state allows the calculation of Percent Idle Management Effectiveness (%IME). IME is the result of the operation of the APU plus the implementation of CSXT's Warm Weather Shutdown Policy. It is difficult to separate the two. The units demonstrated an IME of 64% at stationary idle for the test period. The data collected during calendar year 2004 demonstrated that 707,600 gallons of fuel were saved and 285 tons of NOX were not emitted as a result of idle management in stationary idle, which translates to 12,636 gallons and 5.1 tons of NOx per unit respectively. The noise reduction capabilities of the APU demonstrated that at 150 feet from the locomotive the loaded APU with the main engine shut down generated noise that was only marginally above ambient noise level.« less

The Republicanization of evangelical Protestants in the United States: An examination of the sources of political realignment.

PubMed

Schwadel, Philip

2017-02-01

Although the association between evangelical Protestant and Republican affiliations is now a fundamental aspect of American politics, this was not the case as recently as the early 1980s. Following work on secular political realignment and the issue evolution model of partisan change, I use four decades of repeated cross-sectional survey data to examine the dynamic correlates of evangelical Protestant and Republican affiliations, and how these factors promote changes in partisanship. Results show that evangelical Protestants have become relatively more likely to attend religious services and to oppose homosexuality, abortion, and welfare spending. Period-specific mediation models show that opposition to abortion, homosexuality, and welfare spending have become more robust predictors of Republican affiliation. By the twenty-first century, differences in Republican affiliation between evangelical Protestants and other religious affiliates are fully mediated by views of homosexuality, abortion, and welfare spending; and differences in Republican affiliation between evangelicals and the religiously unaffiliated are substantially mediated by views of homosexuality, abortion, welfare spending, and military spending. These results further understanding of rapid changes in politico-religious alignments and the increasing importance of moral and cultural issues in American politics, which supports a culture wars depiction of the contemporary political landscape. Copyright © 2016 Elsevier Inc. All rights reserved.

National health expenditures, 1991

PubMed Central

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

1992-01-01

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

Buying time promotes happiness.

PubMed

Whillans, Ashley V; Dunn, Elizabeth W; Smeets, Paul; Bekkers, Rene; Norton, Michael I

2017-08-08

Around the world, increases in wealth have produced an unintended consequence: a rising sense of time scarcity. We provide evidence that using money to buy time can provide a buffer against this time famine, thereby promoting happiness. Using large, diverse samples from the United States, Canada, Denmark, and The Netherlands ( n = 6,271), we show that individuals who spend money on time-saving services report greater life satisfaction. A field experiment provides causal evidence that working adults report greater happiness after spending money on a time-saving purchase than on a material purchase. Together, these results suggest that using money to buy time can protect people from the detrimental effects of time pressure on life satisfaction.

Buying time promotes happiness

PubMed Central

Whillans, Ashley V.; Dunn, Elizabeth W.; Smeets, Paul; Bekkers, Rene; Norton, Michael I.

2017-01-01

Around the world, increases in wealth have produced an unintended consequence: a rising sense of time scarcity. We provide evidence that using money to buy time can provide a buffer against this time famine, thereby promoting happiness. Using large, diverse samples from the United States, Canada, Denmark, and The Netherlands (n = 6,271), we show that individuals who spend money on time-saving services report greater life satisfaction. A field experiment provides causal evidence that working adults report greater happiness after spending money on a time-saving purchase than on a material purchase. Together, these results suggest that using money to buy time can protect people from the detrimental effects of time pressure on life satisfaction. PMID:28739889

Integrating Public Health and Personal Care in a Reformed US Health Care System

PubMed Central

Chernichovsky, Dov

2010-01-01

Compared with other developed countries, the United States has an inefficient and expensive health care system with poor outcomes and many citizens who are denied access. Inefficiency is increased by the lack of an integrated system that could promote an optimal mix of personal medical care and population health measures. We advocate a health trust system to provide core medical benefits to every American, while improving efficiency and reducing redundancy. The major innovation of this plan would be to incorporate existing private health insurance plans in a national system that rebalances health care spending between personal and population health services and directs spending to investments with the greatest long-run returns. PMID:20019310

Impact of the Basic Education Program on Educational Spending and Equity in Tennessee.

ERIC Educational Resources Information Center

Goldhaber, Dan; Callahan, Karen

2001-01-01

Examines state- and district-level spending patterns in Tennessee to assess the extent to which the Basic Education Program (BEP) funding formula has affected spending in the state and spending in districts with varying characteristics, for example, poverty status of students, school district size. Suggests that BEP led to greater education…

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

PubMed

Lee, Ronald; Miller, Timoth

2002-10-01

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

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.

Alaska's Dependence on State Spending. ISER Fiscal Policy Papers, No. 5.

ERIC Educational Resources Information Center

Goldsmith, Scott; And Others

Alaska will face a large fiscal gap and growing budget deficits in the near future. The timing of such fiscal gap open hinges on the joint effect of state budget growth and the oil price change. This paper explains Alaska's dependence on state spending and offers policy options addressing the fiscal gap. State spending: (1) supports nearly one in…

Area-level variations in cancer care and outcomes.

PubMed

Keating, Nancy L; Landrum, Mary Beth; Lamont, Elizabeth B; Bozeman, Samuel R; McNeil, Barbara J

2012-05-01

: Substantial regional variations in health-care spending exist across the United States; yet, care and outcomes are not better in higher-spending areas. Most studies have focused on care in fee-for-service Medicare; whether spillover effects exist in settings without financial incentives for more care is unknown. : We studied care for cancer patients in fee-for-service Medicare and the Veterans Health Administration (VA) to understand whether processes and outcomes of care vary with area-level Medicare spending. : An observational study using logistic regression to assess care by area-level measures of Medicare spending. : Patients with lung, colorectal, or prostate cancers diagnosed during 2001-2004 in Surveillance, Epidemiology, and End Results (SEER) areas or the VA. The SEER cohort included fee-for-service Medicare patients aged older than 65 years. : Recommended and preference-sensitive cancer care and mortality. : In fee-for-service Medicare, higher-spending areas had higher rates of recommended care (curative surgery and adjuvant chemotherapy for early-stage non-small-cell lung cancer and chemotherapy for stage III colon cancer) and preference-sensitive care (chemotherapy for stage IV lung and colon cancer and primary treatment of local/regional prostate cancer) and had lower lung cancer mortality. In the VA, we observed minimal variation in care by area-level Medicare spending. : Our findings suggest that intensity of care for Medicare beneficiaries is not driving variations in VA care, despite some overlap in physician networks. Although the Dartmouth Atlas work has been of unprecedented importance in demonstrating variations in Medicare spending, new measures may be needed to better understand variations in other populations.

Changes in Teaching Hospitals' Community Benefit Spending After Implementation of the Affordable Care Act.

PubMed

Alberti, Philip M; Sutton, Karey M; Baker, Matthew

2018-05-22

U.S. teaching hospitals that qualify as 501(c)(3) organizations (a not-for-profit designation) are required to demonstrate community benefit annually. Increases in health insurance access driven by Affordable Care Act (ACA) implementation, along with new regulations, research opportunities, and educational expectations, may be changing hospitals' allocations of community benefit dollars. This study aimed to describe changes in teaching hospitals' community benefit spending between 2012 (pre-ACA implementation) and 2015 (post-ACA implementation), and to explore differences in spending changes between hospitals in Medicaid expansion and non-expansion states. In 2017, for each teaching hospital member of the Association of American Medical Colleges' (AAMC's) Council of Teaching Hospitals and Health Systems required to submit Form 990s to the Internal Revenue Service, the authors sought community benefit spending data for 2012 and 2015 as reported on Schedule H. The analysis included 169 pairs of Form 990s representing 184 AAMC member teaching hospitals (93% of 198 eligible hospitals). Compared with 2012, hospitals in 2015 spent $3.1 billion (20.14%) more on community benefit despite spending $804 million (16.17%) less on charity care. Hospitals in Medicaid expansion states increased spending on subsidized health services and Medicaid shortfalls at rates higher than hospitals in non-expansion states. The latter increased spending at higher rates on community health improvement and cash/in-kind contributions. After ACA implementation, teaching hospitals increased their overall community benefit spending while their charity care spending declined. Changes in community benefit spending differed according to states' Medicaid expansion status, demonstrating hospitals' responsiveness to state and local realities.

Explaining the Growth in US Health Care Spending Using State-Level Variation in Income, Insurance, and Provider Market Dynamics

PubMed Central

Herring, Bradley; Trish, Erin

2015-01-01

The slowed growth in national health care spending over the past decade has led analysts to question the extent to which this recent slowdown can be explained by predictable factors such as the Great Recession or must be driven by some unpredictable structural change in the health care sector. To help address this question, we first estimate a regression model for state personal health care spending for 1991-2009, with an emphasis on the explanatory power of income, insurance, and provider market characteristics. We then use the results from this simple predictive model to produce state-level projections of health care spending for 2010-2013 to subsequently compare those average projected state values with actual national spending for 2010-2013, finding that at least 70% of the recent slowdown in health care spending can likely be explained by long-standing patterns. We also use the results from this predictive model to both examine the Great Recession’s likely reduction in health care spending and project the Affordable Care Act’s insurance expansion’s likely increase in health care spending. PMID:26655685

National study of public spending for mental retardation and developmental disabilities.

PubMed

Braddock, D; Hemp, R; Fujiura, G

1987-09-01

Results of a nationwide study of public mental retardation/developmental disabilities (MR/DD) spending in the states during Fiscal Years 1977 through 1986 were summarized. Trends identified included: (a) continuing growth in spending for community services, (b) contraction of total spending for institutional operations, and (c) predominance of ICF/MR support in large (16+ beds) congregate care settings. Periodic replication of the study was recommended as was additional research to identify the political and economic determinants of state MR/DD spending.

Biological and ecological science for Michigan—The Great Lakes State

USGS Publications Warehouse

,

2018-04-04

Michigan is rich in lakes, rivers, dune and rocky shorelines, forests, fish and wildlife, and has the longest freshwater coastline in the United States, 3,224 miles. Many enterprises critical to Michigan’s economy and cultural heritage are based on natural resources including commercial and sport fishing, hunting, and other outdoor recreation. Overall, outdoor recreation is enjoyed by more than 63 percent of Michigan residents, and has been estimated to generate $18.7 billion in consumer spending, create 194,000 jobs, and raise $1.4 billion in State and local tax revenue annually.

Development of a Cost-Effectiveness Methodology to Prioritize Environmental Mitigation Projects

DTIC Science & Technology

1993-09-01

GEOMET Technologies, Inc., 1991:2.4- 2.16). Other factors that determine exposure to home radon is time spent at home and equilibrium factor of radon ... daughters . The EPA assumes that people in the United States spend about 75% of their time in the home, based on a study by GEOMET (EPA, 1992:2.13, 2.33

Parents and the High Cost of Child Care: 2013 Report

ERIC Educational Resources Information Center

Wood, Stephen; Kendall, Rosemary

2013-01-01

Every week in the United States, nearly 11 million children younger than age 5 are in some type of child care arrangement. On average, these children spend 36 hours a week in child care. While parents are children's first and most important teachers, child care programs provide early learning for millions of young children daily, having a profound…

Building Automation and the Contextualization of Information Technology: The Journey of a Midwestern Community College in the U.S.

ERIC Educational Resources Information Center

Grandgenett, Neal; Perry, Pam; Pensabene, Thomas; Wegner, Karen; Nirenberg, Robert; Pilcher, Phil; Otterpohl, Candi

2018-01-01

The buildings in which people work, live, and spend their leisure time are increasingly embedded with sophisticated information technology (IT). This article describes the approach of Metropolitan Community College (MCC) in Omaha, Nebraska of the United States to provide an occupational context to some of their IT coursework by organizing IT…

The Best of Times, the Worst of Times: Rising Standards and Declining Staff Qualifications in Early Childhood Education

ERIC Educational Resources Information Center

French, Robert

2010-01-01

Low pay, meager benefits, poor morale, and high turnover impact the daily experience of many early childhood educators in the United States. While public spending in early childhood education has substantially increased in recent years, it has mainly fueled expansion, not quality enhancement to help programs attract, compensate, and retain…

Pathology of wildfire risk: A characterization of social and ecological dimensions

Treesearch

A. Paige Fischer; Thomas A Spies; Toddi A Steelman; Cassandra Moseley; Bart R Johnson; John D Bailey; Alan A Ager; Patrick Bourgeron; Susan Charnley; Brandon M Collins; Jeffrey D Kline; Jessica E Leahy; Jeremy S Littell; James DA Millington; Max Nielsen-Pincus; Christine S Olsen; Travis B Paveglio; Christopher I Roos; Michelle M Steen-Adams; Forrest R Stevens; Jelena Vukomanovic; Eric M White; David M. J. S. Bowman

2016-01-01

Despite dramatic increases in suppression spending, the risk of life and property loss associated with wildfire has continued to rise in recent decades. Economic losses from wildfires have doubled in the United States and suppression expenses have tripled between 2002 and 2012 compared to the decade prior. Loss of property to wildfire has outpaced efforts to reduce...

Emotional Intelligence: A Quantitative Study of the Relationship among Academic Success Factors and Emotional Intelligence

ERIC Educational Resources Information Center

Iannucci, Brian A.

2013-01-01

Researchers have found a correlation between emotional intelligence (EI) and success in the workplace. As a result, many companies have invested a large amount of resources into EI testing during their hiring process. In the United States, corporations are spending over $33 billion on hiring, training, and development. In addition to the increase…

Tests of English Language as Significant Thresholds for College-Bound Chinese and the Washback of Test-Preparation

ERIC Educational Resources Information Center

Matoush, Marylou M.; Fu, Danling

2012-01-01

Tests of English language mark significantly high thresholds for all college-bound students in the People's Republic of China. Many Chinese students hope to seek their fortunes at universities in the United States, or other English speaking countries. These students spend long hours, year after year, in test-preparation centres in order to develop…

45 CFR 1201.9 - Considerations in determining whether the Corporation will comply with a demand or request.

Code of Federal Regulations, 2010 CFR

2010-10-01

... determining whether the Corporation will comply with a demand or request. (a) In deciding whether to comply... discovery or the rules of procedure governing the case or matter in which the demand arose; (2) Whether... conduct of official business; (5) The need to avoid spending the time and money of the United States for...

Students' Experiences of the Implementation of an Interactive Learning System in Their Eighth Grade Mathematics Classes: An Exploratory Study.

ERIC Educational Resources Information Center

FitzPatrick, Sarah B.

During the last decade, United States K-12 schools have approximately tripled their spending on increasingly powerful computers, and have expanded network access and novel computer applications. The number of questions being asked by educators, policymakers, and the general public about the extent to which students are using these educational…

Are Public Master's Institutions Cost Efficient? A Stochastic Frontier and Spatial Analysis

ERIC Educational Resources Information Center

Titus, Marvin A.; Vamosiu, Adriana; McClure, Kevin R.

2017-01-01

The current study examines costs, measured by educational and general (E&G) spending, and cost efficiency at 252 public master's institutions in the United States over a nine-year (2004-2012) period. We use a multi-product quadratic cost function and results from a random-effects model with a first-order autoregressive (AR1) disturbance term…

Housing Resources and Programs for Single Student Parents at Community and Technical Colleges. Fact Sheet #C396

ERIC Educational Resources Information Center

Thorman, Abby; Otto, Jessica; Gunn-Wright, Rhiana

2012-01-01

Parents with dependent children now make up almost one in four students pursuing higher education in the United States (Miller, Gault, and Thorman 2011). Single parents face particular challenges pursuing higher education, including securing safe and affordable housing. Single mothers often must spend over half of their income on housing expenses,…

State Medicaid spending and financial burden of families raising children with autism.

PubMed

Parish, Susan L; Thomas, Kathleen C; Rose, Roderick; Kilany, Mona; Shattuck, Paul T

2012-12-01

We examined the association between state Medicaid spending for children with disabilities and the financial burden reported by families of children with autism. Child and family data were from the 2005-2006 National Survey of Children with Special Health Care Needs (n  =  2,011 insured children with autism). State characteristics were from public sources. The 4 outcomes included any out-of-pocket health care expenditures during the past year, expenditure amount, expenditures as a proportion of family income, and whether additional income was needed to care for a child. We modeled the association between state per capita Medicaid spending for children with disabilities and families' financial burden, controlling for child, family, and state characteristics. Overall, 78% of families raising children with autism had health care expenditures for their child for the prior 12 months; 42% reported expenditures over $500, with 34% spending over 3% of their income. Families living in states with higher per capita Medicaid spending for children with disabilities were significantly less likely to report financial burden. There is a robust relationship between state Medicaid spending for children with disabilities and the financial burdens incurred by families raising children with autism.

Machine-Learning Algorithms to Code Public Health Spending Accounts

PubMed Central

Leider, Jonathon P.; Resnick, Beth A.; Alfonso, Y. Natalia; Bishai, David

2017-01-01

Objectives: Government public health expenditure data sets require time- and labor-intensive manipulation to summarize results that public health policy makers can use. Our objective was to compare the performances of machine-learning algorithms with manual classification of public health expenditures to determine if machines could provide a faster, cheaper alternative to manual classification. Methods: We used machine-learning algorithms to replicate the process of manually classifying state public health expenditures, using the standardized public health spending categories from the Foundational Public Health Services model and a large data set from the US Census Bureau. We obtained a data set of 1.9 million individual expenditure items from 2000 to 2013. We collapsed these data into 147 280 summary expenditure records, and we followed a standardized method of manually classifying each expenditure record as public health, maybe public health, or not public health. We then trained 9 machine-learning algorithms to replicate the manual process. We calculated recall, precision, and coverage rates to measure the performance of individual and ensembled algorithms. Results: Compared with manual classification, the machine-learning random forests algorithm produced 84% recall and 91% precision. With algorithm ensembling, we achieved our target criterion of 90% recall by using a consensus ensemble of ≥6 algorithms while still retaining 93% coverage, leaving only 7% of the summary expenditure records unclassified. Conclusions: Machine learning can be a time- and cost-saving tool for estimating public health spending in the United States. It can be used with standardized public health spending categories based on the Foundational Public Health Services model to help parse public health expenditure information from other types of health-related spending, provide data that are more comparable across public health organizations, and evaluate the impact of evidence-based public health resource allocation. PMID:28363034

Machine-Learning Algorithms to Code Public Health Spending Accounts.

PubMed

Brady, Eoghan S; Leider, Jonathon P; Resnick, Beth A; Alfonso, Y Natalia; Bishai, David

Government public health expenditure data sets require time- and labor-intensive manipulation to summarize results that public health policy makers can use. Our objective was to compare the performances of machine-learning algorithms with manual classification of public health expenditures to determine if machines could provide a faster, cheaper alternative to manual classification. We used machine-learning algorithms to replicate the process of manually classifying state public health expenditures, using the standardized public health spending categories from the Foundational Public Health Services model and a large data set from the US Census Bureau. We obtained a data set of 1.9 million individual expenditure items from 2000 to 2013. We collapsed these data into 147 280 summary expenditure records, and we followed a standardized method of manually classifying each expenditure record as public health, maybe public health, or not public health. We then trained 9 machine-learning algorithms to replicate the manual process. We calculated recall, precision, and coverage rates to measure the performance of individual and ensembled algorithms. Compared with manual classification, the machine-learning random forests algorithm produced 84% recall and 91% precision. With algorithm ensembling, we achieved our target criterion of 90% recall by using a consensus ensemble of ≥6 algorithms while still retaining 93% coverage, leaving only 7% of the summary expenditure records unclassified. Machine learning can be a time- and cost-saving tool for estimating public health spending in the United States. It can be used with standardized public health spending categories based on the Foundational Public Health Services model to help parse public health expenditure information from other types of health-related spending, provide data that are more comparable across public health organizations, and evaluate the impact of evidence-based public health resource allocation.

Colorado Children's Budget 2013

ERIC Educational Resources Information Center

Buck, Beverly; Baker, Robin

2013-01-01

The "Colorado Children's Budget" presents and analyzes investments and spending trends during the past five state fiscal years on services that benefit children. The "Children's Budget" focuses mainly on state investment and spending, with some analysis of federal investments and spending to provide broader context of state…

Analyzing Whether Countries Are Equally Efficient at Improving Longevity for Men and Women

PubMed Central

Nandi, Arijit; Mendoza Rodríguez, José M.; Heymann, Jody

2014-01-01

Objectives. We examined the efficiency of country-specific health care spending in improving life expectancies for men and women. Methods. We estimated efficiencies of health care spending for 27 Organisation for Economic Co-operation and Development (OECD) countries during the period 1991 to 2007 using multivariable regression models, including country fixed-effects and controlling for time-varying levels of national social expenditures, economic development, and health behaviors. Results. Findings indicated robust differences in health-spending efficiency. A 1% annual increase in health expenditures was associated with percent changes in life expectancy ranging from 0.020 in the United States (95% confidence interval [CI] = 0.008, 0.032) to 0.121 in Germany (95% CI = 0.099, 0.143). Health-spending increases were associated with greater life expectancy improvements for men than for women in nearly every OECD country. Conclusions. This is the first study to our knowledge to estimate the effect of country-specific health expenditures on life expectancies of men and women. Future work understanding the determinants of these differences has the potential to improve the overall efficiency and equity of national health systems. PMID:24328639

Spending Money Wisely.

ERIC Educational Resources Information Center

Wentworth, Donald R.; And Others

1982-01-01

The theme article of this issue, "Spending Money Wisely," by Donald R. Wentworth, begins with an explanation of basic strategies which aid wise spending. The article goes on to provide an introduction to economic reasoning related to consumer purchases and focusing on the role of incentives, scarcity, and alternatives. Four teaching units follow…

The financial consequences of too many men: sex ratio effects on saving, borrowing, and spending.

PubMed

Griskevicius, Vladas; Tybur, Joshua M; Ackerman, Joshua M; Delton, Andrew W; Robertson, Theresa E; White, Andrew E

2012-01-01

The ratio of males to females in a population is an important factor in determining behavior in animals. We propose that sex ratio also has pervasive effects in humans, such as by influencing economic decisions. Using both historical data and experiments, we examined how sex ratio influences saving, borrowing, and spending in the United States. Findings show that male-biased sex ratios (an abundance of men) lead men to discount the future and desire immediate rewards. Male-biased sex ratios decreased men's desire to save for the future and increased their willingness to incur debt for immediate expenditures. Sex ratio appears to influence behavior by increasing the intensity of same-sex competition for mates. Accordingly, a scarcity of women led people to expect men to spend more money during courtship, such as by paying more for engagement rings. These findings demonstrate experimentally that sex ratio influences human decision making in ways consistent with evolutionary biological theory. Implications for sex ratio effects across cultures are discussed.

Private enrollments and expenditure on education: Some macro trends

NASA Astrophysics Data System (ADS)

Tan, Jee-Peng

1985-12-01

Many less-developed countries (LDCs) are today facing difficulties in the financing of education. On the one hand, state budgetary allocations to the sector are already very high, and appear likely to grow only slowly, if at all. At the same time, however, the demand for education is rising, not least because of demographic pressures. Without changes in the system, both to reduce unit costs through improving efficiency and to mobilize additional resources for the sector, the level of educational development, particularly in the poorest LDCs, is likely to remain low. Coupled with the stagnation in public spending on education, the data suggest that total national spending in the sector has tended to decline as GDP grew. This trend should perhaps be discouraged since education contributes significantly to economic development. One way of doing so is to increase the share of private participation in total spending in the sector, for example, by increasing the role of private education, especially where it is weak and declining over time.

The Financial Consequences of Too Many Men: Sex Ratio Effects on Saving, Borrowing, and Spending

PubMed Central

Griskevicius, Vladas; Tybur, Joshua M.; Ackerman, Joshua M.; Delton, Andrew W.; Robertson, Theresa E.; White, Andrew E.

2012-01-01

The ratio of males to females in a population is an important factor in determining behavior in animals. We propose that sex ratio also has pervasive effects in humans, such as by influencing economic decisions. Using both historical data and experiments, we examined how sex ratio influences saving, borrowing, and spending in the United States. Findings show that male-biased sex ratios (an abundance of men) lead men to discount the future and desire immediate rewards. Male-biased sex ratios decreased men’s desire to save for the future and increased their willingness to incur debt for immediate expenditures. Sex ratio appears to influence behavior by increasing the intensity of same-sex competition for mates. Accordingly, a scarcity of women led people to expect men to spend more money during courtship, such as by paying more for engagement rings. These findings demonstrate experimentally that sex ratio influences human decision making in ways consistent with evolutionary biological theory. Implications for sex ratio effects across cultures are discussed. PMID:21767031

Effects of state-level public spending on health on the mortality probability in India.

PubMed

Farahani, Mansour; Subramanian, S V; Canning, David

2010-11-01

This study uses the second National Family Health Survey of India to estimate the effect of state-level public health spending on mortality across all age groups, controlling for individual, household, and state-level covariates. We use a state's gross fiscal deficit as an instrument for its health spending. Our study shows a 10% increase in public spending on health in India decreases the average probability of death by about 2%, with effects mainly on the young, the elderly, and women. Other major factors affecting mortality are rural residence, household poverty, and access to toilet facilities. Copyright © 2009 John Wiley & Sons, Ltd.

National health expenditure projections, 2014-24: spending growth faster than recent trends.

PubMed

Keehan, Sean P; Cuckler, Gigi A; Sisko, Andrea M; Madison, Andrew J; Smith, Sheila D; Stone, Devin A; Poisal, John A; Wolfe, Christian J; Lizonitz, Joseph M

2015-08-01

Health spending growth in the United States is projected to average 5.8 percent for 2014-24, reflecting the Affordable Care Act's coverage expansions, faster economic growth, and population aging. Recent historically low growth rates in the use of medical goods and services, as well as medical prices, are expected to gradually increase. However, in part because of the impact of continued cost-sharing increases that are anticipated among health plans, the acceleration of these growth rates is expected to be modest. The health share of US gross domestic product is projected to rise from 17.4 percent in 2013 to 19.6 percent in 2024. Project HOPE—The People-to-People Health Foundation, Inc.

Impact of social service and public health spending on teenage birth rates across the USA: an ecological study.

PubMed

Sipsma, Heather L; Canavan, Maureen; Gilliam, Melissa; Bradley, Elizabeth

2017-06-13

To examine whether greater state-level spending on social and public health services such as income, education and public safety is associated with lower rates of teenage births in USA. Ecological study. USA. 50 states. Our primary outcome measure was teenage birth rates. For analyses, we constructed marginal models using repeated measures to test the effect of social spending on teenage birth rates, accounting for several potential confounders. The unadjusted and adjusted models across all years demonstrated significant effects of spending and suggested that higher spending rates were associated with lower rates of teenage birth, with effects slightly diminishing with each increase in spending (linear effect: B=-0.20; 95% CI -0.31 to 0.08; p<0.001 and quadratic effect: B=0.003; 95% CI 0.002 to 0.005; p<0.001). Higher state spending on social and public health services is associated with lower rates of teenage births. As states seek ways to limit healthcare costs associated with teenage birth rates, our findings suggest that protecting existing social service investments will be critical. © 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 international comparison of government expenditures for energy conservation research and development:

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

McDonald, S.C.

1988-03-01

This study provides a comparison of US and foreign government spending for energy conservation research and development (R and D). The countries included in this analysis are: the United States, United Kingdom, France, Sweden, West Germany, and Japan. The approach of this paper was to compare the research program of each country at a high level of aggregation with the US Department of Energy (DOE) program structure. This paper does not allow for differences in the way each country defines or accounts for research.

Do state characteristics matter? State level factors related to tobacco cessation quitlines

PubMed Central

Keller, Paula A; Koss, Kalsea J; Baker, Timothy B; Bailey, Linda A; Fiore, Michael C

2007-01-01

Background Quitline services are an effective population‐wide tobacco cessation strategy adopted widely in the United States as part of state comprehensive tobacco control efforts. Despite widespread evidence supporting quitlines' effectiveness, many states lack sufficient financial resources to adequately fund and promote this service. Efforts to augment state tobacco control efforts might be fostered by greater knowledge of state level factors associated with the funding and implementation of those efforts. Methods We analysed data from the 2004 North American Quitline Consortium survey and from publicly available sources to identify state level factors related to quitline implementation and funding. Factors included in the analyses were state demographic characteristics, tobacco use variables, state tobacco control spending, and economic and political climate variables. Univariate and multivariate regression analyses were conducted. Results The best fitting multivariate model that significantly predicted the presence or absence of a state quitline included only cigarette excise tax rate (p = 0.020). In terms of funding levels, states with high rates of cigarette consumption (p = 0.047) and with higher per capita expenditures for tobacco control programmes (p = 0 .0.004) were most likely to spend more on per capita operations budget for quitlines. Conclusion State level factors appear to play a part in whether states had established quitlines by mid‐2004 and the amount of per capita quitline funding. PMID:18048637

How and why do countries differ in their governance and financing-related administrative expenditure in health care? An analysis of OECD countries by health care system typology.

PubMed

Hagenaars, Luc L; Klazinga, Niek S; Mueller, Michael; Morgan, David J; Jeurissen, Patrick P T

2018-01-01

Administration is vital for health care. Its importance may increase as health care systems become more complex, but academic attention has remained minimal. We investigated trends in administrative expenditure across OECD countries, cross-country spending differences, spending differences between health care system typologies, and differences in the scale and scope of administrative functions across typologies. We used OECD data, which include health system governance and financing-related administrative activities by regulators, governance bodies, and insurers (macrolevel), but exclude administrative expenditure by health care providers (mesolevel and microlevel). We find that governance and financing-related administrative spending at the macrolevel has remained stable over the last decade at slightly over 3% of total health spending. Cross-country differences range from 1.3% of health spending in Iceland to 8.3% in the United States. Voluntary private health insurance bears much higher administrative costs than compulsory schemes in all countries. Among compulsory schemes, multiple payers exhibit significantly higher administrative spending than single payers. Among single-payer schemes, those where entitlements are based on residency have significantly lower administrative spending than those with single social health insurance, albeit with a small difference. These differences can partially be explained because multi-payer and voluntary private health insurance schemes require additional administrative functions and enjoy less economies of scale. Studies in hospitals and primary care indicate similar differences in administrative costs across health system typologies at the mesolevel and microlevel of health care delivery, which warrants more research on total administrative costs at all the levels of health systems. Copyright © 2017 John Wiley & Sons, Ltd.

Impact of social service and public health spending on teenage birth rates across the USA: an ecological study

PubMed Central

Sipsma, Heather L; Canavan, Maureen; Gilliam, Melissa; Bradley, Elizabeth

2017-01-01

Objective To examine whether greater state-level spending on social and public health services such as income, education and public safety is associated with lower rates of teenage births in USA. Design Ecological study. Setting USA. Participants 50 states. Primary outcome measure Our primary outcome measure was teenage birth rates. For analyses, we constructed marginal models using repeated measures to test the effect of social spending on teenage birth rates, accounting for several potential confounders. Results The unadjusted and adjusted models across all years demonstrated significant effects of spending and suggested that higher spending rates were associated with lower rates of teenage birth, with effects slightly diminishing with each increase in spending (linear effect: B=−0.20; 95% CI −0.31 to 0.08; p<0.001 and quadratic effect: B=0.003; 95% CI 0.002 to 0.005; p<0.001). Conclusion Higher state spending on social and public health services is associated with lower rates of teenage births. As states seek ways to limit healthcare costs associated with teenage birth rates, our findings suggest that protecting existing social service investments will be critical. PMID:28611088

Connecting Spending and Results: Tying Dollars Spent to National, Campus Goals

ERIC Educational Resources Information Center

Wellman, Jane

2009-01-01

As Americans near the end of the first decade of the new millennium, higher education in the United States is caught in a classic "good news/bad news" dilemma. The good news? Broad recognition of the importance of higher education to the country's future, along with larger federal funding increases than at any time in their history. The bad news?…

Grantmakers and Thought Leaders on Out-of-School Time: Survey & Interview Report

ERIC Educational Resources Information Center

Traphagen, Kathleen

2014-01-01

It is often noted that children spend most of their waking hours out of school. What they do during non-school hours is important, because access to high-quality learning, both in and out-of-school, is key to cognitive, social-emotional, and physical development. In the United States today, demand for after-school programs outstrips supply: 8.4…

America COMPETES Act: Programs, Funding, and Selected Issues

DTIC Science & Technology

2008-01-22

Additional congressional actions also focused on increasing corporate spending on research and development in response to competitiveness concerns...NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Congressional Research Service ,101 Independence...States may not be able to compete economically with other nations in the future due to insufficient investment today in science and technology research

The MHS Pharmacy Benefit: Efficacy of Civilian Cost Saving Strategies

DTIC Science & Technology

2006-12-01

Administration and members of the Public Health Service and their dependents. The healthcare benefits that they receive differ from the benefits received by...previous years ( National Health Expenditure, 2005). The Center for Medicare and Medicaid services forecasts that actual spending in the United States...Medicaid Services . (2005). National Health Expenditure Accounts, Retrieved June 2006, from http://www.cms.hhs.gov/NationalHealthExpendData/ Census

U.S. and Chilean College Students' Reading Practices: A Cross-Cultural Perspective

ERIC Educational Resources Information Center

Huang, Suhua; Orellana, Pelusa; Capps, Matthew

2016-01-01

The purpose of this study was to investigate the differences between the amounts of time that U.S. and Chilean students spend on conventional academic reading, extracurricular reading, and Facebook and also to report the types of materials they prefer to read. The study surveyed students in the United States (n = 1,265) and Chile (n = 2,076)…

The Productivity Push: System-Wide Reform Allows Arizona to Serve More Students. Lumina Foundation Focus[TM]. Summer 2010

ERIC Educational Resources Information Center

Giegerich, Steve

2010-01-01

Today, the United States spends about twice as much on higher education as the average developed nation, but many other countries are doing a better job of graduating more students at substantially lower expense. To provide more high-quality degrees and credentials at lower cost, colleges and universities must become high-performing institutions.…

Employer-Sponsored Recurrent Education in the United States: A Report on Recent Inquiries into Its Structure.

ERIC Educational Resources Information Center

Smith, G. B.

Employer-sponsored recurrent (or lifelong) learning has grown from its World War II beginnings to become a large, important, but little-studied aspect of American education, one with major implications for the U.S. economy and society. U.S. employers spend from 20 to 100 billion dollars on educational programs for anywhere from 37 to 73 million…

The Impact of Geographic Information Systems on Emergency Management Decision Making at the U.S. Department of Homeland Security

ERIC Educational Resources Information Center

King, Steven Gray

2012-01-01

Geographic information systems (GIS) reveal relationships and patterns from large quantities of diverse data in the form of maps and reports. The United States spends billions of dollars to use GIS to improve decisions made during responses to natural disasters and terrorist attacks, but precisely how GIS improves or impairs decision making is not…

Pricing Public Parks and Recreation Services as a Percent of Per Capita Income: The Creation of a National Pricing Model.

ERIC Educational Resources Information Center

Kelsey, Craig W.; Smith, S. Harold

This study of public parks and recreation agencies throughout the United States was undertaken to develop a mathematical pricing formula sensitive to local spending abilities in order to determine if a per capita pricing structure would be possible. Four hundred and seventy public parks and recreation agencies responded to a survey of fees and…

Industrial R&D Spending Reached $26.6 Billion in 1976. Science Resources Studies Highlights, May 5, 1978.

ERIC Educational Resources Information Center

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

This report presents data compiled as part of a comprehensive program to measure and analyze the nation's resources expended for research and development (R&D). Industry, which carries out 69% of the R&D in the United States, spent $26.6 billion on these activities in 1976, 10% above the 1975 level. In constant dollars, this presents an…

Military Commission Proceedings at Guantanamo Bay - U.S. Department of

Science.gov Websites

U.S. Army soldier stands guard as a detainee spends time in the exercise yard outside Camp Five at the Five is one of six camps that comprise the detention center and has been built with many features that can be found in many maximum-security prisons in the United States. Camp Five is where the most non

Child Labor in the Early Sugar Beet Industry in the Great Plains, 1890-1920

ERIC Educational Resources Information Center

Lyons-Barrett, Mary

2005-01-01

Children working in agriculture have always been a part of the rural culture and work ethos of the United States, especially on the Great Plains. Many teenagers still detassel corn or walk the beans in the summer months to earn spending money or money for college. But what about the children who work as migrant laborers in commercialized…

Value for the money spent? Exploring the relationship between expenditures, insurance adequacy, and access to care for publicly insured children.

PubMed

Colby, Margaret S; Lipson, Debra J; Turchin, Sarah R

2012-04-01

This study examines the relationship between total state Medicaid spending per child and measures of insurance adequacy and access to care for publicly insured children. Using the 2007 National Survey of Children's Health, seven measures of insurance adequacy and health care access were examined for publicly insured children (n = 19,715). Aggregate state-level measures were constructed, adjusting for differences in demographic, health status, and household characteristics. Per member per month (PMPM) state Medicaid spending on children ages 0-17 was calculated from capitated, fee-for-service, and administrative expenses. Adjusted measures were compared with PMPM state Medicaid spending in scatter plots, and multilevel logistic regression models tested how well state-level expenditures predicted individual adequacy and access measures. Medicaid spending PMPM was a significant predictor of both insurance adequacy and receipt of mental health services. An increase of $50 PMPM was associated with a 6-7 % increase in the likelihood that insurance would always cover needed services and allow access to providers (p = 0.04) and a 19 % increase in the likelihood of receiving mental health services (p < 0.01). For the remaining four measures, PMPM was a consistent (though not statistically significant) positive predictor. States with higher total spending per child appear to assure better access to care for Medicaid children. The policies or incentives used by the few states that get the greatest value--lower-than-median spending and higher-than-median adequacy and access--should be examined for potential best practices that other states could adapt to improve value for their Medicaid spending.

State Education Trends: Academic Performance and Spending over the Past 40 Years. Policy Analysis No. 746

ERIC Educational Resources Information Center

Coulson, Andrew J.

2014-01-01

Long-term trends in academic performance and spending are valuable tools for evaluating past education policies and informing current ones. But such data have been scarce at the state level, where the most important education policy decisions are made. State spending data exist reaching back to the 1960s, but the figures have been scattered across…

Workforce Investment Act: States' Spending Is on Track, But Better Guidance Would Improve Financial Reporting. Report to Congressional Requesters.

ERIC Educational Resources Information Center

General Accounting Office, Washington, DC.

The U.S. Congress asked the Government Accounting Office (GAO) to determine the following: (1) to what extent states were spending their Workforce Investment Act (WIA) funds and whether the Department of Labor's (Labor's) data accurately reflected available funds; (2) what Labor did to assess how states were managing their WIA spending; and (3)…

Federal Funding Insulated State Budgets From Increased Spending Related To Medicaid Expansion.

PubMed

Sommers, Benjamin D; Gruber, Jonathan

2017-05-01

As states weigh whether to expand Medicaid under the Affordable Care Act (ACA) and Medicaid reform remains a priority for some federal lawmakers, fiscal considerations loom large. As part of the ACA's expansion of eligibility for Medicaid, the federal government paid for 100 percent of the costs for newly eligible Medicaid enrollees for the period 2014-16. In 2017 states will pay some of the costs for new enrollees, with each participating state's share rising to 10 percent by 2020. States continue to pay their traditional Medicaid share (roughly 25-50 percent, depending on the state) for previously eligible enrollees. We used data for fiscal years 2010-15 from the National Association of State Budget Officers and a difference-in-differences framework to assess the effects of the expansion's first two fiscal years. We found that the expansion led to an 11.7 percent increase in overall spending on Medicaid, which was accompanied by a 12.2 percent increase in spending from federal funds. There were no significant increases in spending from state funds as a result of the expansion, nor any significant reductions in spending on education or other programs. States' advance budget projections were also reasonably accurate in the aggregate, with no significant differences between the projected levels of federal, state, and Medicaid spending and the actual expenses as measured at the end of the fiscal year. Project HOPE—The People-to-People Health Foundation, Inc.

Estimating Time Physicians and Other Health Care Workers Spend with Patients in an Intensive Care Unit Using a Sensor Network.

PubMed

Butler, Rachel; Monsalve, Mauricio; Thomas, Geb W; Herman, Ted; Segre, Alberto M; Polgreen, Philip M; Suneja, Manish

2018-04-09

Time and motion studies have been used to investigate how much time various health care professionals spend with patients as opposed to performing other tasks. However, the majority of such studies are done in outpatient settings, and rely on surveys (which are subject to recall bias) or human observers (which are subject to observation bias). Our goal was to accurately measure the time physicians, nurses, and critical support staff in a medical intensive care unit spend in direct patient contact, using a novel method that does not rely on self-report or human observers. We used a network of stationary and wearable mote-based sensors to electronically record location and contacts among health care workers and patients under their care in a 20-bed intensive care unit for a 10-day period covering both day and night shifts. Location and contact data were used to classify the type of task being performed by health care workers. For physicians, 14.73% (17.96%) of their time in the unit during the day shift (night shift) was spent in patient rooms, compared with 40.63% (30.09%) spent in the physician work room; the remaining 44.64% (51.95%) of their time was spent elsewhere. For nurses, 32.97% (32.85%) of their time on unit was spent in patient rooms, with an additional 11.34% (11.79%) spent just outside patient rooms. They spent 11.58% (13.16%) of their time at the nurses' station and 23.89% (24.34%) elsewhere in the unit. From a patient's perspective, we found that care times, defined as time with at least one health care worker of a designated type in their intensive care unit room, were distributed as follows: 13.11% (9.90%) with physicians, 86.14% (88.15%) with nurses, and 8.14% (7.52%) with critical support staff (eg, respiratory therapists, pharmacists). Physicians, nurses, and critical support staff spend very little of their time in direct patient contact in an intensive care unit setting, similar to reported observations in both outpatient and inpatient settings. Not surprisingly, nurses spend far more time with patients than physicians. Additionally, physicians spend more than twice as much time in the physician work room (where electronic medical record review and documentation occurs) than the time they spend with all of their patients combined. Copyright © 2018 Elsevier Inc. All rights reserved.

Near-term capital spending in the North American power industry

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

Burt, B.; Mullins, S.

2007-01-15

The article provides a snapshot of activity in the four distinct North American electric power generation niches - coal, nuclear, gas and renewables. Consideration of capacity and investment levels are a viable way of comparing growth trends. Coal still remains the fuel of choice for most new North American units. Between now and 2010 some 25 coal-fired units are scheduled to come on-line; another 246 units are in earlier stages of development. In 2005, spending on renewable energy development surpassed investment in gas-fired unit construction for the first time. 4 photos.

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

PubMed Central

Lee, Ronald; Miller, Timothy

2002-01-01

Objective To quantify uncertainty in forecasts of health expenditures. Study Design Stochastic time series models are estimated for historical variations in fertility, mortality, and health spending per capita in the United States, and used to generate stochastic simulations of the growth of Medicare expenditures. Individual health spending is modeled to depend on the number of years until death. Data Sources/Study Setting A simple accounting model is developed for forecasting health expenditures, using the U.S. Medicare system as an example. Principal Findings Medicare expenditures are projected to rise from 2.2 percent of GDP (gross domestic product) to about 8 percent of GDP by 2075. This increase is due in equal measure to increasing health spending per beneficiary and to population aging. The traditional projection method constructs high, medium, and low scenarios to assess uncertainty, an approach that has many problems. Using stochastic forecasting, we find a 95 percent probability that Medicare spending in 2075 will fall between 4 percent and 18 percent of GDP, indicating a wide band of uncertainty. Although there is substantial uncertainty about future mortality decline, it contributed little to uncertainty about future Medicare spending, since lower mortality both raises the number of elderly, tending to raise spending, and is associated with improved health of the elderly, tending to reduce spending. Uncertainty about fertility, by contrast, leads to great uncertainty about the future size of the labor force, and therefore adds importantly to uncertainty about the health-share of GDP. In the shorter term, the major source of uncertainty is health spending per capita. Conclusions History is a valuable guide for quantifying our uncertainty about future health expenditures. The probabilistic model we present has several advantages over the high–low scenario approach to forecasting. It indicates great uncertainty about future Medicare expenditures relative to GDP. PMID:12479501

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.

Out-of-School Time Is Critical for Children: Who Participates in Programs? Research-to-Results Fact Sheet. Publication #2006-20

ERIC Educational Resources Information Center

Theokas, Christina; Bloch, Margot

2006-01-01

School-age children and adolescents in the United States have a lot of discretionary time (6.5 to 8 hours per day). Participating in organized out-of-school time programs and activities is one constructive and safe way that children can spend their free time. These activities can provide supervision, fun, and opportunities to develop new skills…

The Relationship of Technology Funding on Adequate Yearly Progress Objectives Met in South Carolina School Districts

ERIC Educational Resources Information Center

Davis, Myron E.

2012-01-01

Technology has become more of a necessity for everyday use. It not only plays a crucial role in everyday use, it is also vital in the educational arena. Since the advent of the current technology age, technology has become an important educational tool in U.S. schools. Spending on technology. for K-12 education in the United States has jumped, and…

Family Support or School Readiness? Contrasting Models of Public Spending on Children's Early Care and Learning. Evidence Speaks Reports, Vol 1, #16

ERIC Educational Resources Information Center

Whitehurst, Grover J.

2016-01-01

In the United States, public policy and expenditure intended to improve the prospects of children from low-income families have focused on better preparing children for school through Head Start and universal pre-K. This school readiness approach differs from the dominant model of public support for early care and learning in Northern Europe,…

Alternative Strategic Environments, 1994-2004.

DTIC Science & Technology

1985-01-01

ability to sustain a heavy burden of defense spending politically. The study assumes that in the "surprise-free" forecast Europe will remain divided...nationalistic discontent and impa- tience with Soviet control. The possibility of an overt Soviet intervention is expected to remain high. Because of its own prob...development would be particularly important for the United States and its allies, as 3apan and several West European nations are projected to remain

Implementing the Small Business Innovation Development Act--The First 2 Years.

DTIC Science & Technology

1985-10-25

GENERAL Report To The Congress OF THE UNITED STATES , Implementing The Small Business Innovation Development Act--The First 2 Years (AD I The 1982 act...seeks to encourage innovation and small business participation in federal Sresearch. Among other requirements, agen- cies spending more than $100...million annu- !* ally for external research must award por- tions of their external research dollars to small businesses . This first of several

Spending Analysis of Government Purchase Card Buys for United States Navy Destroyers

DTIC Science & Technology

2009-12-01

1). By utilizing Simplified 2 Acquisition Procedures (SAP) and Electronic Funds Transfer ( EFT ), governmental entities including the Department...policy or regulation is unclear. While this is in essence no different from the relationship as it exists regarding stock -numbered supply system...invoice cited the purchased material only using a local stock number, e.g., 3ea Item 32-4405N $75, purchase card requests and amplifying

Military Review. July-August 2011

DTIC Science & Technology

2011-08-01

IGHTING THE SO-CALLED “information war” against terrorists andinsurgents has cost the U.S. military nearly $1 billion in the past three years.1 But that...may not be the highest cost . Congressional questions about the spending for communication programs and news reports about questionable use of...strategic communications during the wars in Iraq and Afghanistan. In the end, these well-intended schemes might cost the United States its credibil­

Academic R&D Spending Maintains Growth from All Major Sources in FY 2001. Info Brief.

ERIC Educational Resources Information Center

Machen, M. Marge; Shackelford, Brandon

Data from the Academic Research and Development (R&D) Survey and other surveys were used to analyze patterns of R&D activity in the United States. For the purpose of this analysis, the most recent data update from the report "National Patterns of R&D Resources" adjusts university and college R&D performance to net out R&D expenditures reported as…

A Multiple Case Study of Challenges and Successes Experienced by Founders and Directors of Nature-Based Preschools in the United States

ERIC Educational Resources Information Center

Barnett, Alexandra Michaela

2016-01-01

Nature-based preschools are defined as educational settings in which children spend three or more hours per school day in natural environments such as woods, meadows, and beaches (Knight, 2013). The purpose of this qualitative, multiple case study was to obtain a deep understanding of the challenges and successes of nature-based preschool (NBP)…

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

PubMed Central

Jencks, Stephen F.; Schieber, George J.

1992-01-01

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

A Framework for Measuring Low-Value Care.

PubMed

Miller, George; Rhyan, Corwin; Beaudin-Seiler, Beth; Hughes-Cromwick, Paul

2018-04-01

It has been estimated that more than 30% of health care spending in the United States is wasteful, and that low-value care, which drives up costs unnecessarily while increasing patient risk, is a significant component of wasteful spending. To address the need for an ability to measure the magnitude of low-value care nationwide, identify the clinical services that are the greatest contributors to waste, and track progress toward eliminating low-value use of these services. Such an ability could provide valuable input to the efforts of policymakers and health systems to improve efficiency. We reviewed existing methods that could contribute to measuring low-value care and developed an integrated framework that combines multiple methods to comprehensively estimate and track the magnitude and principal sources of clinical waste. We also identified a process and needed research for implementing the framework. A comprehensive methodology for measuring and tracking low-value care in the United States would provide an important contribution toward reducing waste. Implementation of the framework described in this article appears feasible, and the proposed research program will allow moving incrementally toward full implementation while providing a near-term capability for measuring low-value care that can be enhanced over time. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Military Spending and Economic Well-Being in the American States: The Post-Vietnam War Era

ERIC Educational Resources Information Center

Borch, Casey; Wallace, Michael

2010-01-01

Using growth curve modeling techniques, this research investigates whether military spending improved or worsened the economic well-being of citizens within the American states during the post-Vietnam War period. We empirically test the military Keynesianism claim that military spending improves the economic conditions of citizens through its use…

US energy for the rest of the century, 1984 edition

NASA Astrophysics Data System (ADS)

Gustaferro, J. F.

1984-07-01

The U.S. energy consumption and supply for two years 1983 and 2000 is presented. In 1983 the United States consumed about 70.5 quadrillion British thermal units of energy. A U.S. energy consumption of about 84 quadrillion British thermal units in the year 2000 is projected. The 84 quadrillion British thermal units consists of 13 million barrels per day of petroleum, 18 trillion cubic feet of natural gas and 3.5 trillion kilowatt hours of electricity. Coal production is projected at 1,405 million tons which includes exports. The data presented in the 1984 forecast over the spectrum of U.S. energy requirements and focus on the end use of energy operational purposes, e.g., highway transportation, space heating, lighting, and construction. Data on fuel consumption by types and energy content for 1983 and as projected for the year 2000 is provided. End users of energy in the United States currently spend $441 billion annually for energy. This includes direct taxes.

Cost analysis in a CMHC: determining the cost of staff time.

PubMed

Haring, A; Eckert, C

1979-06-01

The program evaluation and research unit of a community mental health center developed and field-tested a survey form to measure how employees spend their time. The form is divided into direct patient care activities, which include interviewing and testing, conducting therapy, and prescribing medications, and administrative or support activities, which include filling out charts, attending meetings, and training staff. All staff record daily, for one week, the hours and minutes they spend in each activity. Using that data as a base, the evaluation unit can determine the percentage of time staff spend in each activity and the cost of each activity based on staff members' paychecks.

Does equity in healthcare spending exist among Indian states? Explaining regional variations from national sample survey data.

PubMed

Dwivedi, Rinshu; Pradhan, Jalandhar

2017-01-14

Equity and justice in healthcare payment form an integral part of health policy and planning. In the majority of low and middle-income countries (LMICs), healthcare inequalities are further aggravated by Out of Pocket Expenditure (OOPE). This paper examines the pattern of health equity and regional disparities in healthcare spending among Indian states by applying Andersen's behavioural model of healthcare utilization. The present study uses data from the 66 th quinquennial round of Consumer Expenditure Survey, of the National Sample Survey Organization (NSSO), conducted in 2009-10 by Ministry of Statistics and Programme Implementation (MoSPI), Government of India (GoI). To measure equity and regional disparities in healthcare expenditure, states have been categorized under three heads on the basis of monthly OOPE i.e., Category A (OOPE > =INR 100); Category B (OOPE between INR 50 to 99) and Category C (OOPE < INR 50). Multiple Generalised Linear Regression Model (GLRM) has been employed to explore the effect of various socio-economic covariates on the level of OOPE. The gap in the ratio of average healthcare spending between the poorest and richest households was maximum in Category A states (richest/poorest = 14.60), followed by Category B (richest/poorest 11.70) and Category C (richest/poorest 11.40). Results also indicate geographical concentration of lower level healthcare spending among Indian states (e.g., Odisha, Chhattisgarh and all the north-eastern states). Results from the multivariate analysis suggest that people residing in urban areas, having higher economic status, belonging to non-Muslim communities, non-Scheduled Tribes (STs), and non-poor households spend more on healthcare than their counterparts. In spite of various efforts by the government to reduce the burden of healthcare spending, widespread inequalities in healthcare expenditure are prevalent. Households with high healthcare needs (SCs/STs, and the poor) are in a more disadvantaged position in terms of spending on health care. It has also been observed that spending on healthcare was comparatively lower among backward or isolated states. No doubt, the overall social security measures should be enhanced, but at the same time, looking at the regional differences, more priority should be assigned to the disadvantaged states to reduce the burden of OOPE. It is proposed that there is need to increase government spending, especially for the disadvantaged states and population, to minimise the burden of OOPE.

Franchising Education: Challenges and Opportunities for Coping with the Economic Recession and the Provision of Higher Education in the United Kingdom

ERIC Educational Resources Information Center

Miller, Paul; Shotte, Gertrude

2010-01-01

When the global economic recession hit the world some 18 months ago, very few could predict the impact this would have on government spending on higher education. Higher education institutions in the United Kingdom face spending cuts. Notwithstanding, they are expected to deliver quality education with fewer resources. This article discusses…

The Cost of Saving Electricity Through Energy Efficiency Programs Funded by Utility Customers: 2009–2015

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

Hoffman, Ian M.; Goldman, Charles A.; Murphy, Sean

The average cost to utilities to save a kilowatt-hour (kWh) in the United States is 2.5 cents, according to the most comprehensive assessment to date of the cost performance of energy efficiency programs funded by electricity customers. These costs are similar to those documented earlier. Cost-effective efficiency programs help ensure electricity system reliability at the most affordable cost as part of utility planning and implementation activities for resource adequacy. Building on prior studies, Berkeley Lab analyzed the cost performance of 8,790 electricity efficiency programs between 2009 and 2015 for 116 investor-owned utilities and other program administrators in 41 states. Themore » Berkeley Lab database includes programs representing about three-quarters of total spending on electricity efficiency programs in the United States.« less

Choosing Wisely: A Neurosurgical Perspective on Neuroimaging for Headaches

PubMed Central

Hawasli, Ammar H.; Chicoine, Michael R.; Dacey, Ralph G.

2016-01-01

Multiple national initiatives seek to curb spending in order to address increasing health care costs in the United States. The Choosing Wisely® initiative is one popular initiative that focuses on reducing health care spending by setting guidelines to limit tests and procedures requested by patients and ordered by physicians. To reduce spending on neuroimaging, the Choosing Wisely® initiative and other organizations have offered guidelines to limit neuroimaging for headaches. Although the intentions are laudable, these guidelines are inconsistent with the neurosurgeon’s experience with brain tumor patients. If adopted by governing or funding organizations, these guidelines threaten to negatively impact the care and outcomes of patients with brain tumors, who frequently present with minimal symptoms or isolated headaches syndromes. As we grapple with the difficult conflict between evidence-based cost-cutting guidelines and individualized patient-tailored medicine, a physician must carefully balance the costs and benefits of discretionary services such as neuroimaging for headaches. By participating in the development of validated clinical decision rules on neuroimaging for headaches, neurosurgeons can advocate for their patients and improve their patients’ outcomes. PMID:25255253

National Study of Public Spending for Mental Retardation and Developmental Disabilities.

ERIC Educational Resources Information Center

Braddock, David; And Others

1987-01-01

Results of a nationwide study of public mental retardation/developmental disabilities spending in the states during Fiscal Years 1977 through 1986 were analyzed and identified trends such as continuing growth in spending for community services, contraction of total spending for institutional operations, and predominance of support for intermediate…

77 FR 38035 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-26

... government spending and 35.8 percent of state government spending. This comprehensive and ongoing, time series collection of local education agency finances maintains historical continuity in the state and...

Ethical considerations in the orthopaedic relationship with industry.

PubMed

Sarmiento, A

2007-06-01

Members of the medical profession spend a long time and financial resources acquiring the knowledge necessary for the discharge of their responsibilities; therefore, they should be appropriately compensated for the services they provide. However, it has become obvious, at least in the United States, that excessive emphasis on profit making is fostering the transformation of the medical profession into strictly a business. This transformation is spawning ethical infractions, which are becoming increasingly apparent.

Medicare, Medicaid, and Maternal and Child Health Block Grant Budget Issues. Hearing before the Committee on Finance. United States Senate, One Hundredth Congress, First Session (July 8 and 9, 1987). Part 1 of 2.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. Senate Committee on Finance.

This document presents witnesses' testimonies and prepared statements from two of three Senate hearings called to examine budget issues affecting the Medicare, Medicaid, and Maternal and Child Health Block Grant programs, including changes in the Medicare program necessary to reduce spending in accordance with the budget resolution and expansions…

Coastal Inlets as Strategic Habitat for Shorebirds in the Southeastern United States

DTIC Science & Technology

2008-10-01

population (C. melodus circum- cinctus) ( Goossen et al. 2002), the bulk of which spend the winter nonbreeding season on the U.S. southeastern coast ( Goossen ...provided by Mr. Casey Lott (American Bird Conservancy); Dr. Jim Fraser (Virginia Polytechnic Institute); and Drs. Richard A. Fischer and Michael P...eastern American Oystercatchers. Journal of Wildlife Management 69:1538-1545. Goossen , J. P., D. L. Amirault, J. Arndt, R. Bjorge, S. Boates, J. Brazil

Warranties for Weapons: Theory and Initial Assessment.

DTIC Science & Technology

1987-04-01

the warranty on the C-17 air vehicle.2 This warranty calls for the field measurement of some five maintainability parameters, redesign and retrofit of...NOTE N-2479-AF Warranties for Weapons: Theory and Initial Assessment James P. Stucker, Giles K. Smith April 1987 Prepared for The United States Air Force...cost, schedule, performance, and reliability? The Air Force and the other Services currently are spending a lot of money and effort specifying

Estimating DoD Transportation Spending: Analyses of Contract and Payment Transactions

DTIC Science & Technology

2007-01-01

the Defense Logistics Agency (DLA) and of expenditures by shipment material and volume (or cube). The analysis of DLA expenditures appears in Appendix...Defense Logistics Agency (DLA) not completely captured in DD350 data. Limited implementation outside the United States confines inferences that can be...Defense Information Systems Agency DLA Defense Logistics Agency DoD U.S. Department of Defense DoDAAC U.S. Department of Defense Activity Address Code

Spending on social and public health services and its association with homicide in the USA: an ecological study

PubMed Central

Sipsma, Heather L; Canavan, Maureen E; Rogan, Erika; Taylor, Lauren A; Talbert-Slagle, Kristina M; Bradley, Elizabeth H

2017-01-01

Objective To examine whether state-level spending on social and public health services is associated with lower rates of homicide in the USA. Design Ecological study. Setting USA. Participants All states in the USA and the District of Columbia for which data were available (n=42). Primary outcome measure Homicide rates for each state were abstracted from the US Department of Justice Federal Bureau of Investigation’s Uniform Crime Reporting. Results After adjusting for potential confounding variables, we found that every $10 000 increase in spending per person living in poverty was associated with 0.87 fewer homicides per 100 000 population or approximately a 16% decrease in the average homicide rate (estimate=−0.87, SE=0.15, p<0.001). Furthermore, there was no significant effect in the quartile of states with the highest percentages of individuals living in poverty but significant effects in the quartiles of states with lower percentages of individuals living in poverty. Conclusions Based on our findings, spending on social and public health services is associated with significantly lower homicide rates at the state level. Although we cannot infer causality from this research, such spending may provide promising avenues for homicide reduction in the USA, particularly among states with lower levels of poverty. PMID:29025831

Meeting the need for personal care among the elderly: does Medicaid home care spending matter?

PubMed

Kemper, Peter; Weaver, France; Short, Pamela Farley; Shea, Dennis; Kang, Hyojin

2008-02-01

To determine whether Medicaid home care spending reduces the proportion of the disabled elderly population who do not get help with personal care. Data on Medicaid home care spending per poor elderly person in each state is merged with data from the Medicare Current Beneficiary Survey for 1992, 1996, and 2000. The sample (n=6,067) includes elderly persons living in the community who have at least one limitation in activities of daily living (ADLs). Using a repeated cross-section analysis, the probability of not getting help with an ADL is estimated as a function of Medicaid home care spending, individual income, interactions between income and spending, and a set of individual characteristics. Because Medicaid home care spending is targeted at the low-income population, it is not expected to affect the population with higher incomes. We exploit this difference by using higher-income groups as comparison groups to assess whether unobserved state characteristics bias the estimates. Among the low-income disabled elderly, the probability of not receiving help with an ADL limitation is about 10 percentage points lower in states in the top quartile of per capita Medicaid home care spending than in other states. No such association is observed in higher-income groups. These results are robust to a set of sensitivity analyses of the methods. These findings should reassure state and federal policymakers considering expanding Medicaid home care programs that they do deliver services to low-income people with long-term care needs and reduce the percent of those who are not getting help.

Politics, Interest Groups and State Funding of Public Higher Education

ERIC Educational Resources Information Center

Tandberg, David A.

2010-01-01

State support of public higher education has rapidly declined relative to total state spending. Much of this decline in support is due to the rapid growth in spending on such things as Medicaid. However, relative support of public higher education varies significantly between states. This study applies Tandberg's (2009) fiscal policy framework…

Whistleblowing in the pharmaceutical industry in the United States, England, Canada, and Australia.

PubMed

Boumil, Sylvester James; Nariani, Ashiyana; Boumil, Marcia M; Berman, Harris A

2010-04-01

Fraud and abuse in the spending of public monies plague governments around the world. In the United States the False Claims Act encourages whistleblowing by private individuals to expose evidence of fraud. They are rewarded for their efforts with monetary compensation and protection from retaliation. Such is not the case in Canada, England, and Australia. Although some recent legislation has increased the protections afforded to whistleblowers, they are still likely to be viewed more as disloyal employees than courageous public servants, and there is little incentive to risk their jobs and reputation. Qui tam laws provide a police force of thousands in the effort to reduce rampant fraud, waste, and abuse, and would be an asset in any health-care system where pubic health policy requires conservation of resources.

2014 National Park visitor spending effects: economic contributions to local communities, states, and the nation

USGS Publications Warehouse

Cullinane Thomas, Catherine; Huber, Christopher; Koontz, Lynne

2015-01-01

New this year, results from the Visitor Spending Effects report series are available online via an interactive tool. Users can explore current year visitor spending, jobs, labor income, value added, and output effects by sector for national, state, and local economies. This interactive tool is available via the NPS Social Science Program webpage at http://www.nature.nps.gov/socialscience/economics.cfm.

Vertical nuclear proliferation.

PubMed

Sidel, Victor W

2007-01-01

All the nuclear-weapon states are working to develop new nuclear-weapon systems and upgrade their existing ones. Although the US Congress has recently blocked further development of small nuclear weapons and earth-penetrating nuclear weapons, the United States is planning a range of new warheads under the Reliable Replacement Warhead programme, and renewing its nuclear weapons infrastructure. The United Kingdom is spending 1 billion pounds sterling on updating the Atomic Weapons Establishment at Aldermaston, and about 20 billion pounds sterling on replacing its Vanguard submarines and maintaining its Trident warhead stockpile. The US has withdrawn from the Anti-Ballistic Missile Treaty and plans to install missile defence systems in Poland and the Czech Republic; Russia threatens to upgrade its nuclear countermeasures. The nuclear-weapon states should comply with their obligations under Article VI of the Non-Proliferation Treaty, as summarised in the 13-point plan agreed at the 2000 NPT Review Conference, and they should negotiate a Nuclear Weapons Convention.

Ethnic Heterogeneity, Group Affinity, and State Higher Education Spending

ERIC Educational Resources Information Center

Foster, John M.; Fowles, Jacob

2018-01-01

A rich interdisciplinary literature exists exploring the determinants of state higher education funding policies. However, that work has collectively ignored an important finding from political economy literature: namely, that citizens' preferences regarding public spending are strongly influenced by the state's ethnic and racial context. Drawing…

Does Deinstitutionalization Increase Suicide?

PubMed Central

Yoon, Jangho; Bruckner, Tim A

2009-01-01

Objectives (1) To test whether public psychiatric bed reduction may increase suicide rates; (2) to investigate whether the supply of private hospital psychiatric beds—separately for not-for-profit and for-profit—can substitute for public bed reduction without increasing suicides; and (3) to examine whether the level of community mental health resources moderates the relationship between public bed reduction and suicide rates. Methods We examined state-level variation in suicide rates in relation to psychiatric beds and community mental health spending in the United States for the years 1982–1998. We categorize psychiatric beds separately for public, not-for-profit, and for-profit hospitals. Principal Findings Reduced public psychiatric bed supply was found to increase suicide rates. We found no evidence that not-for-profit or for-profit bed supply compensates for public bed reductions. However, greater community mental health spending buffers the adverse effect of public bed reductions on suicide. We estimate that in 2008, an additional decline in public psychiatric hospital beds would raise suicide rates for almost all states. Conclusions Downsizing of public inpatient mental health services may increase suicide rates. Nevertheless, an increase in community mental health funding may be promising. PMID:19500164

HEALTH CARE SPENDING GROWTH AND THE FUTURE OF U.S. TAX RATES

PubMed Central

Baicker, Katherine; Skinner, Jonathan S.

2011-01-01

The fraction of GDP devoted to health care in the United States is the highest in the world and rising rapidly. Recent economic studies have highlighted the growing value of health improvements, but less attention has been paid to the efficiency costs of tax-financed spending to pay for such improvements. This paper uses a life cycle model of labor supply, saving, and longevity improvement to measure the balanced-budget impact of continued growth in the Medicare and Medicaid programs. The model predicts that top marginal tax rates could rise to 70 percent by 2060, depending on the progressivity of future tax changes. The deadweight loss of the tax system is greater when the financing is more progressive. If the share of taxes paid by high-income taxpayers remains the same, the efficiency cost of raising the revenue needed to finance the additional health spending is $1.48 per dollar of revenue collected, and GDP declines (relative to trend) by 11 percent. A proportional payroll tax has a lower efficiency cost (41 cents per dollar of revenue averaged over all tax hikes, a 5 percent drop in GDP) but more than doubles the share of the tax burden borne by lower income taxpayers. Empirical support for the model comes from analysis of OECD country data showing that countries facing higher tax burdens in 1979 experienced slower health care spending growth in subsequent decades. The rising burden imposed by the public financing of health care expenditures may therefore serve as a brake on health care spending growth. PMID:21608156

State planning in New Jersey

DOT National Transportation Integrated Search

1998-12-31

In trying to develop a state plan for to guide regulatory and spending decision-making on land use and spending on transportation facilities and other forms of infrastructure, New Jersey has rejected mandatory compliance in favor of seeking voluntary...

Updated Budget Projections: 2016 to 2026

DTIC Science & Technology

2016-03-01

flexibility to use tax and spending policies to respond to unexpected challenges.  The probability of a fiscal crisis in the United States would...baseline, after accounting for all of the government’s borrowing needs, shows debt held by the public rising from $13.1 trillion at the end of 2015 to...2016 remain unchanged from last year’s 18.2 percent (see Table 3). Receipts of individual income taxes are expected to edge up by 0.1 percentage point

What to Do About That Pack of Wolves at the Door: A Binational Organization and Acquisitions Approach to Homeland Cruise Missile Defense

DTIC Science & Technology

2016-04-04

throughout the world . While the United States and its near-peer competitors have focused their non-proliferation treaties, missile defense...The Absolute Weapon: Atomic Power and World Order (Yale: Harcourt Brace, 1946), 76. 2 US Census Bureau Report (2010). 3 destruction (WMDs). The...spending, procurement, and capabilities. Russia’s involvement in Georgia, Ukraine, and Syria demonstrate this desire for greater influence in world

Financial Crisis; Department of Defense Spending: How to Control Fraud, Waste, and Abuse in the Military

DTIC Science & Technology

2012-04-25

problem that continues to cost billions of dollars in losses at a time when the United States Military and Federal Government can least afford it. It...to look like. The federal budget has become the leading issue affecting every Government Agency. The military’s budget is decreasing by more than...discuss the cost savings measures and initiatives currently being debated in Washington, and offer, for debate, several new recommendations that have

Medicare Part D Payments for Topical Steroids

PubMed Central

Song, Hannah; Adamson, Adewole

2017-01-01

Importance Rising pharmaceutical costs in the United States are an increasing source of financial burden for payers and patients. Although topical steroids are among the most commonly prescribed medications in dermatology, there are limited data on steroid-related spending and utilization. Objective To characterize Medicare and patient out-of-pocket costs for topical steroids, and to model potential savings that could result from substitution of the cheapest topical steroid from the corresponding potency class. Design, Setting, and Participants This study was a retrospective cost analysis of the Medicare Part D Prescriber Public Use File, which details annual drug utilization and spending on both generic and branded drugs from 2011 to 2015 by Medicare Part D participants who filled prescriptions for topical steroids. Main Outcomes and Measures Total and potential Medicare and out-of-pocket patient spending. Costs were adjusted for inflation and reported in 2015 dollars. Results Medicare Part D expenditures on topical steroids between 2011 and 2015 were $2.3 billion. Patients’ out-of-pocket spending for topical steroids over the same period was $333.7 million. The total annual spending increased from $237.6 million to $775.9 million, an increase of 226.5%. Patients’ annual out-of-pocket spending increased from $41.4 million to $101.8 million, an increase of 145.9%. The total number of prescriptions were 7.7 million in 2011 and 10.6 million in 2015, an increase of 37.0%. Generic medication costs accounted for 97.8% of the total spending during this time period. The potential health care savings and out-of-pocket patient savings from substitution of the cheapest topical steroid within the corresponding potency class were $944.8 million and $66.6 million, respectively. Conclusions and Relevance Most topical steroids prescribed were generic drugs. There has been a sharp increase in Medicare and out-of-pocket spending on topical steroids that is driven by higher costs for generics. Use of clinical decision support tools to enable substitution of the most affordable generic topical steroid from the corresponding potency class may reduce drug expenditures. PMID:28453645

Is Medicaid sustainable? Spending projections for the program's second forty years.

PubMed

Kronick, Richard; Rousseau, David

2007-01-01

We constructed long-term projections of Medicaid spending and compared projected growth in spending with that of state and federal revenues. Notwithstanding the anticipated decline in employer-sponsored insurance and the long-term care needs of the baby boomers, we project that Medicaid spending as a share of national health spending will average 16.6 percent from 2006 to 2025--roughly unchanged from 16.5 percent in 2005--and then increase slowly to 19.0 percent by 2045. Growth in government revenues is projected to be large enough to sustain both Medicaid spending increases and substantial real growth in spending for other services.

Easy Money: Tax Exporting and State Support for Higher Education

ERIC Educational Resources Information Center

Foster, John M.; Fowles, Jacob

2016-01-01

There is a substantial literature that assesses the effects of tax-exporting capacities on the tax structures and aggregate spending levels that state governments choose to implement, but no work exists that isolates the effects of state tax exporting on higher education spending. Using state-level data for 1989, 1995, 2002, and 2007, we estimate…

Who administers? Who cares? Medical administrative and clinical employment in the United States and Canada.

PubMed Central

Himmelstein, D U; Lewontin, J P; Woolhandler, S

1996-01-01

OBJECTIVES. We compared US and Canadian health administration costs using national medical care employment data for both countries. METHODS. Data from census surveys on hospital, nursing home, and outpatient employment in the United States (1968 to 1993) and Canada (1971 and 1986) were analyzed. RESULTS. Between 1968 and 1993, US medical care employment grew from 3.976 to 10.308 million full-time equivalents. Administration grew from 0.719 to 2.792 million full-time equivalents, or from 18.1% to 27.1% of the total employment. In 1986, the United States deployed 33,666 health care full-time equivalent personnel per million population, and Canada deployed 31,529. The US excess was all administrative; Canada employed more clinical personnel, especially registered nurses. Between 1971 and 1986, hospital employment per capita grew 29% in the United States (mostly because of administrative growth) and fell 14% in Canada. In 1986, Canadian hospitals still employed more clinical staff per million. Outpatient employment was larger and grew faster in the United States. Per capita nursing home employment was substantially higher in Canada. CONCLUSIONS. If US hospitals and outpatient facilities adopted Canada's staffing patterns, 1,407,000 fewer managers and clerks would be necessary. Despite lower medical spending, Canadians receive slightly more nursing and other clinical care than Americans, as measured by labor inputs. PMID:8633732

Spending on social and public health services and its association with homicide in the USA: an ecological study.

PubMed

Sipsma, Heather L; Canavan, Maureen E; Rogan, Erika; Taylor, Lauren A; Talbert-Slagle, Kristina M; Bradley, Elizabeth H

2017-10-12

To examine whether state-level spending on social and public health services is associated with lower rates of homicide in the USA. Ecological study. USA. All states in the USA and the District of Columbia for which data were available (n=42). Homicide rates for each state were abstracted from the US Department of Justice Federal Bureau of Investigation's Uniform Crime Reporting. After adjusting for potential confounding variables, we found that every $10 000 increase in spending per person living in poverty was associated with 0.87 fewer homicides per 100 000 population or approximately a 16% decrease in the average homicide rate (estimate=-0.87, SE=0.15, p<0.001). Furthermore, there was no significant effect in the quartile of states with the highest percentages of individuals living in poverty but significant effects in the quartiles of states with lower percentages of individuals living in poverty. Based on our findings, spending on social and public health services is associated with significantly lower homicide rates at the state level. Although we cannot infer causality from this research, such spending may provide promising avenues for homicide reduction in the USA, particularly among states with lower levels of poverty. © 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.

Taxing & Spending in the Silver State.

ERIC Educational Resources Information Center

Nevada Public Affairs Review, 1979

1979-01-01

This issue of the "Nevada Public Affairs Review" focused primarily on the politics of state taxing and spending in Nevada. The articles present several aspects of this topic, including a comparison of taxation in Nevada with that in other states, an analysis of the growth of the gaming industry in Nevada, an argument for removing…

Health spending, illicit financial flows and tax incentives in Malawi.

PubMed

O'Hare, B; Curtis, M

2014-12-01

This analysis examines the gaps in health care financing in Malawi and how foregone taxes could fill these gaps. It begins with an assessment of the disease burden and government health expenditure. Then it analyses the tax revenues foregone by the government of Malawi by two main routes: Illicit financial flows (IFF) from the country, Tax incentives. We find that there are significant financing gaps in the health sector; for example, government expenditure is United States Dollars (USD) 177 million for 2013/2014 while projected donor contribution in 2013/2014 is USD 207 million and the total cost for the minimal health package is USD 535 million. Thus the funding gap between the government budget for health and the required spending to provide the minimal package for 2013/2014 is USD 358 million. On the other hand we estimate that almost USD 400 million is lost through IFF and corporate utilization of tax incentives each year. The revenues foregone plus the current government health spending would be sufficient to cover the minimal public health package for all Malawians and would help tackle Malawi's disease burden. Every effort must be made, including improving transparency and revising laws, to curtail IFF and moderate tax incentives.

Children in an aging society.

PubMed

Uhlenberg, Peter

2009-06-01

This article explores ways in which population aging in the United States between 2010 and 2030 might impact the well-being of children, with a distinction made between advantaged and disadvantaged children. A variety of economic and demographic statistics are used to describe the changing age structure of the population and changing public spending on older people and children. Data from the 1985 General Social Survey and Wave 2 of the National Survey of Families and Households are also used to examine connections between older people and children. In recent decades, there has been a graying of the federal budget, and programs for children have received a declining proportion of domestic spending. These trends will be exaggerated between 2010 and 2030 unless structural changes occur. Grandparents may provide increasing resources for their grandchildren. Age segregation results in relatively few older people being directly involved with children not related to them by kinship. The implications of population aging for children are relevant primarily for disadvantaged children. Disadvantaged children have grandparents with fewest resources and are most in need of public spending. As costs of supporting the older population increase, intentional social changes will be needed to prevent growing inequality among children.

Housing issues and realities facing grandparent caregivers who are renters.

PubMed

Fuller-Thomson, Esme; Minkler, Meredith

2003-02-01

This study determined the prevalence of grandparents raising grandchildren who are living in rental housing and explored the sociodemographic characteristics and challenges faced by such renters. Data were obtained from the Census 2000 Supplementary Survey, a nationally representative survey of 700,000 households with a response rate of 96.8%. Frequencies and bivariate analyses were focused on the 2,639 respondents who were grandparent caregiver renters. Of the 2,350,000 grandparent caregivers in the United States in 2000, 26% were renters, almost one third of whom were spending 30% or more of their income on rent. For the quarter of a million grandparent caregiver renters living below the poverty line, 60% were spending at least 30% of their household income on rent and 3 of 10 were living in overcrowded conditions. Grandparent caregivers who are renters represent a particularly vulnerable population. The need for further research, policy, and programs for this group is discussed.

States' spending for public welfare and their suicide rates, 1960 to 1995: what is the problem?

PubMed

Zimmerman, Shirley L

2002-06-01

Drawing on Durkheim's theory of social integration, this discussion reports on findings from a pooled time-series analysis of states' spending for public welfare and their suicide rates, controlling for states' divorce rates, population change rates, population density, unemployment rates, sex ratio, and racial composition. The analysis spans a 35-year period, 1960 to 1995, at six different data points: 1960, 1970, 1980, 1985, 1990, and 1995. The major hypothesis was that states' suicide rates would increase with decreases in per capita spending for public welfare, controlling for the variables listed above in three different models and using OLS to analyze the data. In the basic model, states' spending for public welfare showed no relationship to states' suicide rates; in the second model that controlled for data year and in the third model that controlled for both data year and state, its relationship was significant, but in a negative direction. Suicide rates increased in states that reduced their per capita expenditures for public welfare during the observational period. Of all the variables, the influence of divorce on suicide was the most persistent and pronounced, followed by the percentage of whites in states' populations. Whether the findings reflect an increase in the unendurable psychological pain associated with suicide, or the weakening of ties that bind individuals to each other and to the larger society (as measured by states' divorce rates and per capita expenditures for public welfare), or the vulnerabilities associated with race, states can help counter suicide trends and such negative influences as divorce as evidenced by states that spend more for public welfare and have lower suicide rates. Given that clinicians work with people experiencing the unendurable psychological pain associated with suicide, the findings from these analyses have relevance for their practice.

Health Care Use and Spending for Medicaid Enrollees in Federally Qualified Health Centers Versus Other Primary Care Settings

PubMed Central

Lee, Sang Mee; Sharma, Ravi; Ngo-Metzger, Quyen; Mukamel, Dana B.; Gao, Yue; White, Laura M.; Shi, Leiyu; Chin, Marshall H.; Laiteerapong, Neda; Huang, Elbert S.

2016-01-01

Objectives. To compare health care use and spending of Medicaid enrollees seen at federally qualified health centers versus non–health center settings in a context of significant growth. Methods. Using fee-for-service Medicaid claims from 13 states in 2009, we compared patients receiving the majority of their primary care in federally qualified health centers with propensity score–matched comparison groups receiving primary care in other settings. Results. We found that health center patients had lower use and spending than did non–health center patients across all services, with 22% fewer visits and 33% lower spending on specialty care and 25% fewer admissions and 27% lower spending on inpatient care. Total spending was 24% lower for health center patients. Conclusions. Our analysis of 2009 Medicaid claims, which includes the largest sample of states and more recent data than do previous multistate claims studies, demonstrates that the health center program has provided a cost-efficient setting for primary care for Medicaid enrollees. PMID:27631748

Place of death among older Americans: does state spending on home- and community-based services promote home death?

PubMed

Muramatsu, Naoko; Hoyem, Ruby L; Yin, Hongjun; Campbell, Richard T

2008-08-01

The majority of Americans die in institutions although most prefer to die at home. States vary greatly in their proportion of home deaths. Although individuals' circumstances largely determine where they die, health policies may affect the range of options available to them. To examine whether states' spending on home- and community-based services (HCBS) affects place of death, taking into consideration county health care resources and individuals' family, sociodemographic, and health factors. Using exit interview data from respondents in the Health and Retirement Study born in 1923 or earlier who died between 1993 and 2002 (N = 3362), we conducted discrete-time survival analysis of the risk of end-of-life nursing home relocation to examine whether states' HCBS spending would delay or prevent end-of-life nursing home admission. Then we ran logistic regression analysis to investigate the HCBS effects on place of death separately for those who relocated to a nursing home and those who remained in the community. Living in a state with higher HCBS spending was associated with lower risk of end-of-life nursing home relocation, especially among people who had Medicaid. However, state HCBS support was not directly associated with place of death. States' generosity for HCBS increases the chance of dying at home via lowering the risk of end-of-life nursing home relocation. State-to-state variation in HCBS spending may partly explain variation in home deaths. Our findings add to the emerging encouraging evidence for continued efforts to enhance support for HCBS.

Why We Need to Build a Culture of Health in the United States.

PubMed

Lavizzo-Mourey, Risa

2015-07-01

The United States spends $2.7 trillion a year on health care, more than any other country by far, and yet the U.S. population is not healthy. In fact, the United States loses $227 billion in productivity each year because of poor health. This is not sustainable-and it is the reason behind the Robert Wood Johnson Foundation's Culture of Health initiative. Culture of Health means so much more than simply not being sick. It means embracing a definition of health as outlined by the World Health Organization-a state of complete physical, mental, and social well-being. And it means shifting the values-and the actions-in the United States so that health becomes a part of everything we do. Health is the bedrock of personal fulfillment. It is the backbone of prosperity and the key to creating a strong and competitive nation. With health, children can grow up making the most of life's opportunities. Businesses can rely on the vitality of workers to stay competitive, and the military can perform at its highest level. But there is no single way to cultivate health. This Commentary explores the principles behind the Culture of Health initiative and examines the role of academic medicine in achieving this vision. Different communities must come up with the approaches that serve them best. Only by working toward a common goal in unique ways will a true Culture of Health be attainable in the United States.

National Health Expenditures, 1979

PubMed Central

Gibson, Robert M

1980-01-01

Outlays for health care in the nation reached $212.2 billion in calendar year 1979—12.5 percent higher than in 1978, according to preliminary figures compiled by the Health Care Financing Administration. This estimate represented $943 per person in the United States and was equal to 9.0 percent of the Gross National Product. This latest report in the annual series representing national health expenditures provides detailed estimates of health care spending by type of service and method of financing. PMID:10309255

National Health Expenditures, 1978

PubMed Central

Gibson, Robert M.

1979-01-01

Outlays for health care in the Nation reached $192.4 billion in calendar year 1978--13 percent higher than in 1977, according to preliminary figures compiled by the Health Care Financing Administration. This estimate represented $863 per person in the United States and was equal to 9.1 percent of the GNP. This latest report in the annual series representing national health expenditures provides detailed estimates of health care spending by type of service and method of financing. Revised estimates are presented extending back to 1965. PMID:10309049

The Global Financial Crisis: Lessons from Japan’s Lost Decade of the 1990s

DTIC Science & Technology

2009-05-04

2004. Bernanke cited Milton Friedman and Anna Schwartz’s book, A Monetary History of the United States, 1867-1960, written in 1963, as a basis for...Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for the collection of information is estimated to average 1 hour per response ...have pointed out that the depression ended only after spending for war provided the increase in aggregate demand needed for recovery. In the case of

Setting the Context: Suppression of Enemy Air Defenses and Joint War Fighting in an Uncertain World

DTIC Science & Technology

1994-06-01

indicate, ironically, that the greatest suppression element the Wild Weasel possessed was psychological .9 As much as 95 percent of its effectiveness may...extravagant spending on the latest Soviet LAD systems-made them invulnerable to attack by the Americans, or a belief that the United States was bluffing . What...ARMS may have on the enemy that outweigh system Pk (i.e ., psychological warfare against enemy site operators via intimidation). Methods ofAnalysis In

Demographic characteristics and health care use and expenditures by the aged in the United States: 1977-1984

PubMed Central

Waldo, Daniel R.; Lazenby, Helen C.

1984-01-01

In recent years, increasing attention has been given to the use and financing of health care for the aged. The authors of this article summarize much of the data related to that use, and present original estimates of health spending in 1984 on behalf of the aged. The estimates are designed to indicate trends in health expenditures and are tied to aggregate personal health care expenditures from the National Health Accounts. PMID:10310847

The Budgetary Effects of the United States Participation in the International Monetary Fund

DTIC Science & Technology

2016-06-01

to policymakers and the general public. Proponents of the fair-value approach counter that deci- sions about spending the public’s money should take...member countries, which it must repay, and the amounts owed to members that have lent money to the organiza- tion under the NAB, the GAB, or separate...granted Liberia debt relief in 2010, so it never repaid those new IMF loans in full.1 Because of the relatively small amount of money involved

2013 National Park visitor spending effects: economic contributions to local communities, states, and the nation

USGS Publications Warehouse

Cullinane Thomas, Catherine M.; Huber, Christopher C.; Koontz, Lynne

2014-01-01

While it is typical for visitation levels to fluctuate across the park units each year, system-wide visitation estimates in 2013 declines by 3.2% (or 9.1 million visits) compared ro 2012 (Street, 2014). Although many factors can influence park visitsation, two events signficiantly contrubuterd to this decline: the Government shutdown in October 2013, and lonf-term park closures related to the lasting effects of Hurrican Sandt from October 2012 through July 2013.

United States Air Force Summer Research Program 1991. High School Apprenticeship Program (HSAP) Reports. Volume 10. Armstrong Laboratory

DTIC Science & Technology

1992-01-09

opportunity to spend eight weeks during the summer doing scientific research at the laboratory. Each student is assigned a mentor from the laboratory. During ...AAMRL) 1 A Study on Human Response to Dynamic Impact During Flight Caroline Ch,ag 2 Implementation of the Clean Air Act Relative to Toxicological Research...Crew Rest Intervals for Accelerated MAC Missions: Lessons Lori Olenick from Desert Storm 24 Air Crew Diets During Desert Storm Carol Salinas 25

Doing Drugs and Dropping Out: A Report Prepared for the Use of the Subcommittee on Economic Growth, Trade, and Taxes of the Joint Economic Committee, Congress of the United States. 102d Congress, 1st Session.

ERIC Educational Resources Information Center

Joint Economic Committee, Washington, DC.

This report assesses the societal costs of substance abuse--especially cocaine and crack addition--and dropping out of school. It is organized around three themes: (1) the impact of cocaine and crack abuse in terms of crime, public spending, and lost productivity; (2) policies that move addicts away from crack; and (3) policies that reduce the…

MS Wolf and MS Thomas work on the Cocult experiment together

NASA Image and Video Library

2016-12-15

STS089-364-022 (22-31 Jan. 1998) --- Astronauts David A. Wolf, a new member of the STS-89 crew; and Andrew S. W. Thomas, a new member of the Mir-24 crew, check out the just-unstowed CoCult hardware, a Mir tissue experiment. Wolf will return aboard the space shuttle Endeavour after spending four months on the Russian Mir Space Station. Thomas is the final United States astronaut to serve as guest researcher aboard Mir. Photo credit: NASA

Military Review: The Professional Journal of the U. S. Army. July-August 2011

DTIC Science & Technology

2011-08-01

cost the U.S. military nearly $1 billion in the past three years.1 But that may not be the highest cost . Congressional questions about the spending...intended schemes might cost the United States its credibil- ity. Why did these ill-advised initiatives become so pervasive? How do we meet the need to com...cultures. (Follow-on work is necessary to account for the career development of civilians through integrating a culture and foreign language strategy

Dynamic Energy Budgets and Bioaccumulation: A Model for Marine Mammals and Marine Mammal Populations

DTIC Science & Technology

2006-06-01

energy into them to increase in size, or spend energy to maintain them and stay alive. Supply-side energy budget models have been pioneered by S.A.L.M...of the National Academy of Science of the United States of America 72:4172-4176. Fujiwara, M., and H. Caswell 2001. Demography of the endangered North...fraction of body tissue, which complicates measurements because of heterogeneities within tissues (Aguilar and Borrell 1991). Longevity makes it hard to

Current nuclear threats and possible responses

NASA Astrophysics Data System (ADS)

Lamb, Frederick K.

2005-04-01

Over the last 50 years, the United States has spent more than 100 billion developing and building a variety of systems intended to defend its territory against intercontinental-range ballistic missiles. Most of these systems never became operational and ultimately all were judged ineffective. The United States is currently spending about 10 billion per year developing technologies and systems intended to defend against missiles that might be acquired in the future by North Korea or Iran. This presentation will discuss these efforts ad whether they are likely to be more effective than those of the past. It will also discuss the proper role of anti-ballistic programs at a time when the threat of a nuclear attack on the U.S. by terrorists armed with nuclear weapons is thought to be much higher than the threat of an attack by nuclear-armed ballistic missles.

Proposal of the Physicians' Working Group for Single-Payer National Health Insurance.

PubMed

Woolhandler, Steffie; Himmelstein, David U; Angell, Marcia; Young, Quentin D

2003-08-13

The United States spends more than twice as much on health care as the average of other developed nations, all of which boast universal coverage. Yet more than 41 million Americans have no health insurance. Many more are underinsured. Confronted by the rising costs and capabilities of modern medicine, other nations have chosen national health insurance (NHI). The United States alone treats health care as a commodity distributed according to the ability to pay, rather than as a social service to be distributed according to medical need. In this market-driven system, insurers and providers compete not so much by increasing quality or lowering costs, but by avoiding unprofitable patients and shifting costs back to patients or to other payers. This creates the paradox of a health care system based on avoiding the sick. It generates huge administrative costs that, along with profits, divert resources from clinical care to the demands of business. In addition, burgeoning satellite businesses, such as consulting firms and marketing companies, consume an increasing fraction of the health care dollar. We endorse a fundamental change in US health care--the creation of an NHI program. Such a program, which in essence would be an expanded and improved version of traditional Medicare, would cover every American for all necessary medical care. An NHI program would save at least 200 billion dollars annually (more than enough to cover all of the uninsured) by eliminating the high overhead and profits of the private, investor-owned insurance industry and reducing spending for marketing and other satellite services. Physicians and hospitals would be freed from the concomitant burdens and expenses of paperwork created by having to deal with multiple insurers with different rules, often designed to avoid payment. National health insurance would make it possible to set and enforce overall spending limits for the health care system, slowing cost growth over the long run. An NHI program is the only affordable option for universal, comprehensive coverage.

Telemedicine and competitive change in health care.

PubMed

LaMay, C L

1997-01-01

Telemedicine--the delivery of health care services to the underserved through communications technologies--has the potential to bring medical care to remote areas where health care is either inadequate or nonexistent. Telemedicine can be something as simple as a phone call, a network transmission of a radiograph or other diagnostic image, or, much more advanced, realtime video surgical consultations from anywhere on the globe. Telemedicine programs operate throughout Europe, Japan, and Australia. International programs, for profit and nonprofit, serve Asia, Africa, and the Middle East. The United States is also a major telemedicine developer, principally through government agencies such as the Department of Defense and the Office of Rural Health Policy, and, to a lesser extent, the private sector. But telemedicine in the United States has yet to prove itself economically viable, and it faces a number of political and regulatory barriers. Even more significantly, telemedicine's potential to increase overall health care spending by increasing access to health care has deterred private industry from investing heavily in it. In the short term, telemedicine's most important contribution to health care may be raising fundamental questions about United States health care policy.

State Medicaid Spending and Financial Burden of Families Raising Children with Autism

ERIC Educational Resources Information Center

Parish, Susan L.; Thomas, Kathleen C.; Rose, Roderick; Kilany, Mona; Shattuck, Paul T.

2012-01-01

We examined the association between state Medicaid spending for children with disabilities and the financial burden reported by families of children with autism. Child and family data were from the 2005-2006 National Survey of Children with Special Health Care Needs (n = 2,011 insured children with autism). State characteristics were from public…

State Funding for Students with Disabilities. ECS 50-State Review

ERIC Educational Resources Information Center

Millard, Maria; Aragon, Stephanie

2015-01-01

About 13 percent of all public school students receive special educational services and state spending for these students is rising. In Michigan, for example, spending rose 60 percent from 2000 to 2010. While service costs have been increasing, the share of the costs covered by federal funding has been decreasing. Six years ago, the Individuals…

State Investments in Education and Other Children's Services: Fiscal Profiles of the 50 States.

ERIC Educational Resources Information Center

Gold, Steven D.; And Others

State and local governments are primary funders of education and children's services, directly funding some programs and matching funding from federal or other sources for other programs. Spending on programs for children varies widely. This report brings together data from various sources that, taken together, show spending on children's programs…

Facilities Spending Criticized as Uneven

ERIC Educational Resources Information Center

Greifner, Laura

2006-01-01

This article features a report on states and school districts spending almost $600 billion on building and renovating schools from 1995 to 2004, an amount that far exceed earlier expectations. The report also emphasized the uneven facilities spending between minority and affluent districts. Besides receiving the least money for facilities, the…

Parents’ time with a partner in a cross-national context: A comparison of the United States, Spain, and France

PubMed Central

Roman, Joan Garcia; Flood, Sarah M.; Genadek, Katie R.

2017-01-01

BACKGROUND Time shared with a partner is an indicator of marital well-being and couples want to spend time together. However, time with a partner depends on work and family arrangements as well as the policies, norms, and values that prevail in society. Contrary to time spent with children, couples’ shared time in cross-national context is relatively unstudied. Previous studies from specific countries show that dual-earner couples spend less time together and that parents spend less time alone together. OBJECTIVE The aim of our study is to investigate partnered parents’ shared time across countries to understand how social conditions, cultural norms, and policy contexts are related to the amount and nature of couples’ shared time. Specifically, we compare time with a partner in the US, France, and Spain. METHODS We use data from national time use surveys conducted in the US, France, and Spain. We leverage information about with whom activities are done to examine three types of time shared with a partner for parents with children under age 10: total time with a partner indicates the minutes per day spent in the presence of a partner; exclusive time corresponds to the minutes per day spent alone with a partner when no one else is present; and family time indicates the minutes per day spent with a partner and a child at the same time. RESULTS Our results show that American couples spend the least time together, and Spanish couples spend the most time together. Parents in France spend the most time alone together. The most striking difference across countries is in time with a partner and children, which is much higher among Spanish families. CONCLUSION Paid work constraints explain a small part of the differences in couples’ shared time that we observe between countries. Differences in couples’ shared time across countries seem to be related to social norms surrounding family and general time use. PMID:29416440

Effects of Early Dual-Eligible Special Needs Plans on Health Expenditure.

PubMed

Zhang, Yongkang; Diana, Mark L

2017-10-18

To examine the effects of the penetration of dual-eligible special needs plans (D-SNPs) on health care spending. Secondary state-level panel data from Medicare-Medicaid Linked Enrollee Analytic Data Source (MMLEADS) public use file and Special Needs Plan Comprehensive Reports, Area Health Resource Files, and Medicaid Managed Care Enrollment Report between 2007 and 2011. A difference-in-difference strategy that adjusts for dual-eligibles' demographic and socioeconomic characteristics, state health resources, beneficiaries' health risk factors, Medicare/Medicaid enrollment, and state- and year-fixed effects. Data from MMLEADS were summarized from Centers for Medicare and Medicaid Services (CMS)'s Chronic Conditions Data Warehouse, which contains 100 percent of Medicare enrollment data, claims for beneficiaries who are enrolled in the fee-for-service (FFS) program, and Medicaid Analytic Extract files. The MMLEADS public use file also includes payment information for managed care. Data in Special Needs Plan Comprehensive Reports were from CMS's Health Plan Management System. Results indicate that D-SNPs penetration was associated with reduced Medicare spending per dual-eligible beneficiary. Specifically, a 1 percent increase in D-SNPs penetration was associated with 0.2 percent reduction in Medicare spending per beneficiary. We found no association between D-SNPs penetration and Medicaid or total spending. Involving Medicaid services in D-SNPs may be crucial to improve coordination between Medicare and Medicaid programs and control Medicaid spending among dual-eligible beneficiaries. Starting from 2013, D-SNPs were mandated to have contracts with state Medicaid agencies. This change may introduce new effects of D-SNPs on health care spending. More research is needed to examine the impact of D-SNPs on dual-eligible spending. © Health Research and Educational Trust.

Medicare spending by state: the border-crossing adjustment.

PubMed

Basu, J; Lazenby, H C; Levit, K R

1995-01-01

As the first step in a pioneering effort by the Health Care Financing Administration (HCFA) to measure interstate border crossing for services used by both Medicare and non-Medicare beneficiaries, the authors study the spending behavior of Medicare beneficiaries for 10 Medicare-covered services. Based on interstate flow-of-expenditure data developed for calendar year 1991, the authors analyze the spending patterns of State residents by studying the inflow and outflow rates and the netflow ratios of expenditures incurred by Medicare patients. The report also provides per capita expenditure estimates with residence-based adjustments and evaluates the impact of the border-crossing adjustment for individual services and States.

New Fathers? Residential Fathers’ Time with Children in Four Countries

PubMed Central

Wolfe, Christina M.

2011-01-01

We examine variation in employed fathers’ time with children ages zero to 14, utilizing time use surveys from the United States (2003), Germany (2001), Norway (2000), and the United Kingdom (2000). We examine levels of father involvement and mechanisms associated involvement on both weekdays (N = 4,192) and weekends (N = 3,024). We find some evidence of “new fathers” on weekends in all countries. Fathers spend more time on interactive care and more time alone with children on weekends than on weekdays. Only Norwegian fathers, however, increase both their participation in and time spent on physical care. American and British fathers’ time with children, however, is more responsive to partners’ employment. PMID:22984322

Economic Growth, Productivity, and Public Education Funding: Is South Carolina a Death Spiral State?

ERIC Educational Resources Information Center

Driscoll, Lisa G.; Knoeppel, Robert C.; Della Sala, Matthew R.; Watson, Jim R.

2014-01-01

As a result of the Great Recession of 2007-2009, most states experienced declines in employment, consumer spending, and economic productivity (Alm, Buschman, and Sjoquist 2011). In turn, these events led to historic declines in state tax revenues (Mikesell and Mullins 2010; Boyd and Dadayan 2009), resulting in major cuts in public spending. Local…

45 CFR 400.103 - Coverage of refugees who spend down to State financial eligibility standards.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Welfare OFFICE OF REFUGEE RESETTLEMENT, ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES REFUGEE RESETTLEMENT PROGRAM Refugee Medical Assistance Conditions of Eligibility for Refugee Medical Assistance § 400.103 Coverage of refugees who spend down to State financial eligibility...

State-level income inequality and family burden of U.S. families raising children with special health care needs.

PubMed

Parish, Susan L; Rose, Roderick A; Dababnah, Sarah; Yoo, Joan; Cassiman, Shawn A

2012-02-01

Growing evidence supports the hypothesis that income inequality within a nation influences health outcomes net of the effect of any given household's absolute income. We tested the hypothesis that state-level income inequality in the United States is associated with increased family burden for care and health-related expenditures for low-income families of children with special health care needs. We analyzed the 2005-06 wave of the National Survey of Children with Special Health Care Needs, a probability sample of approximately 750 children with special health care needs in each state and the District of Columbia in the US Our measure of state-level income inequality was the Gini coefficient. Dependent measures of family caregiving burden included whether the parent received help arranging or coordinating the child's care and whether the parent stopped working due to the child's health. Dependent measures of family financial burden included absolute burden (spending in past 12 months for child's health care needs) and relative burden (spending as a proportion of total family income). After controlling for a host of child, family, and state factors, including family income and measures of the severity of a child's impairments, state-level income inequality has a significant and independent association with family burden related to the health care of their children with special health care needs. Families of children with special health care needs living in states with greater levels of income inequality report higher rates of absolute and relative financial burden. Copyright © 2011 Elsevier Ltd. All rights reserved.

Interventional pain management at crossroads: the perfect storm brewing for a new decade of challenges.

PubMed

Manchikanti, Laxmaiah; Singh, Vijay; Boswell, Mark V

2010-01-01

The health care industry in general and care of chronic pain in particular are described as recession-proof. However, a perfect storm with a confluence of many factors and events -none of which alone is particularly devastating - is brewing and may create a catastrophic force, even in a small specialty such as interventional pain management. Multiple challenges related to interventional pain management in the current decade will include individual and group physicians, office practices, ambulatory surgery centers (ASCs), and hospital outpatient departments (HOPD). Rising health care costs are discussed on a daily basis in the United States. The critics have claimed that health outcomes are the same as or worse than those in other countries, but others have presented the evidence that the United States has the best health care system. All agree it is essential to reduce costs. Numerous factors contribute to increasing health care costs. They include administrative costs, waste, abuse, and fraud. It has been claimed the U.S. health care system wastes up to $800 billion a year. Of this, fraud accounts for approximately $200 billion a year, involving fraudulent Medicare claims, kickbacks for referrals for unnecessary services, and other scams. Administrative inefficiency and redundant paperwork accounts for 18% of health care waste, whereas medical mistakes account for $50 billion to $100 billion in unnecessary spending each year, or 11% of the total. Further, American physicians spend nearly 8 hours per week on paperwork and employ 1.66 clerical workers per doctor, more than any other country. It has been illustrated that it takes $60,000 to $88,000 per physician per year, equal to one-third of a family practitioner's gross income, and $23 to $31 billion each year in total to interact with health insurance plans. The studies have illustrated that an average physician spends $68,274 per year communicating with insurance companies and performing other non-medical functions. For an office-based practice, the overall total in the United States is $38.7 billion, or $85,276 per physician. In the United States there are 2 types of physician payment systems: private health care and Medicare. Medicare has moved away from the Medicare Economic Index (MEI) and introduced the sustainable growth rate (SGR) formula which has led to cuts in physician payments on a yearly basis. In 2010 and beyond into the new decade, interventional pain management will see significant changes in how we practice medicine. There is focus on avoiding waste, abuse, fraud, and also cutting costs. Evidence-based medicine (EBM) and comparative effectiveness research (CER) have been introduced as cost-cutting and rationing measures, however, with biased approaches. This manuscript will analyze various issues related to interventional pain management with a critical analysis of physician payments, office facility payments, and ASC payments by various payor groups.

Effects of minimum unit pricing for alcohol on different income and socioeconomic groups: a modelling study

PubMed Central

Holmes, John; Meng, Yang; Meier, Petra S; Brennan, Alan; Angus, Colin; Campbell-Burton, Alexia; Guo, Yelan; Hill-McManus, Daniel; Purshouse, Robin C

2014-01-01

Summary Background Several countries are considering a minimum price policy for alcohol, but concerns exist about the potential effects on drinkers with low incomes. We aimed to assess the effect of a £0·45 minimum unit price (1 unit is 8 g/10 mL ethanol) in England across the income and socioeconomic distributions. Methods We used the Sheffield Alcohol Policy Model (SAPM) version 2.6, a causal, deterministic, epidemiological model, to assess effects of a minimum unit price policy. SAPM accounts for alcohol purchasing and consumption preferences for population subgroups including income and socioeconomic groups. Purchasing preferences are regarded as the types and volumes of alcohol beverages, prices paid, and the balance between on-trade (eg, bars) and off-trade (eg, shops). We estimated price elasticities from 9 years of survey data and did sensitivity analyses with alternative elasticities. We assessed effects of the policy on moderate, hazardous, and harmful drinkers, split into three socioeconomic groups (living in routine or manual households, intermediate households, and managerial or professional households). We examined policy effects on alcohol consumption, spending, rates of alcohol-related health harm, and opportunity costs associated with that harm. Rates of harm and costs were estimated for a 10 year period after policy implementation. We adjusted baseline rates of mortality and morbidity to account for differential risk between socioeconomic groups. Findings Overall, a minimum unit price of £0·45 led to an immediate reduction in consumption of 1·6% (−11·7 units per drinker per year) in our model. Moderate drinkers were least affected in terms of consumption (−3·8 units per drinker per year for the lowest income quintile vs 0·8 units increase for the highest income quintile) and spending (increase in spending of £0·04 vs £1·86 per year). The greatest behavioural changes occurred in harmful drinkers (change in consumption of −3·7% or −138·2 units per drinker per year, with a decrease in spending of £4·01), especially in the lowest income quintile (−7·6% or −299·8 units per drinker per year, with a decrease in spending of £34·63) compared with the highest income quintile (−1·0% or −34·3 units, with an increase in spending of £16·35). Estimated health benefits from the policy were also unequally distributed. Individuals in the lowest socioeconomic group (living in routine or manual worker households and comprising 41·7% of the sample population) would accrue 81·8% of reductions in premature deaths and 87·1% of gains in terms of quality-adjusted life-years. Interpretation Irrespective of income, moderate drinkers were little affected by a minimum unit price of £0·45 in our model, with the greatest effects noted for harmful drinkers. Because harmful drinkers on low incomes purchase more alcohol at less than the minimum unit price threshold compared with other groups, they would be affected most by this policy. Large reductions in consumption in this group would however coincide with substantial health gains in terms of morbidity and mortality related to reduced alcohol consumption. Funding UK Medical Research Council and Economic and Social Research Council (grant G1000043). PMID:24522180

Effects of minimum unit pricing for alcohol on different income and socioeconomic groups: a modelling study.

PubMed

Holmes, John; Meng, Yang; Meier, Petra S; Brennan, Alan; Angus, Colin; Campbell-Burton, Alexia; Guo, Yelan; Hill-McManus, Daniel; Purshouse, Robin C

2014-05-10

Several countries are considering a minimum price policy for alcohol, but concerns exist about the potential effects on drinkers with low incomes. We aimed to assess the effect of a £0·45 minimum unit price (1 unit is 8 g/10 mL ethanol) in England across the income and socioeconomic distributions. We used the Sheffield Alcohol Policy Model (SAPM) version 2.6, a causal, deterministic, epidemiological model, to assess effects of a minimum unit price policy. SAPM accounts for alcohol purchasing and consumption preferences for population subgroups including income and socioeconomic groups. Purchasing preferences are regarded as the types and volumes of alcohol beverages, prices paid, and the balance between on-trade (eg, bars) and off-trade (eg, shops). We estimated price elasticities from 9 years of survey data and did sensitivity analyses with alternative elasticities. We assessed effects of the policy on moderate, hazardous, and harmful drinkers, split into three socioeconomic groups (living in routine or manual households, intermediate households, and managerial or professional households). We examined policy effects on alcohol consumption, spending, rates of alcohol-related health harm, and opportunity costs associated with that harm. Rates of harm and costs were estimated for a 10 year period after policy implementation. We adjusted baseline rates of mortality and morbidity to account for differential risk between socioeconomic groups. Overall, a minimum unit price of £0.45 led to an immediate reduction in consumption of 1.6% (-11.7 units per drinker per year) in our model. Moderate drinkers were least affected in terms of consumption (-3.8 units per drinker per year for the lowest income quintile vs 0.8 units increase for the highest income quintile) and spending (increase in spending of £0.04 vs £1.86 per year). The greatest behavioural changes occurred in harmful drinkers (change in consumption of -3.7% or -138.2 units per drinker per year, with a decrease in spending of £4.01), especially in the lowest income quintile (-7.6% or -299.8 units per drinker per year, with a decrease in spending of £34.63) compared with the highest income quintile (-1.0% or -34.3 units, with an increase in spending of £16.35). Estimated health benefits from the policy were also unequally distributed. Individuals in the lowest socioeconomic group (living in routine or manual worker households and comprising 41.7% of the sample population) would accrue 81.8% of reductions in premature deaths and 87.1% of gains in terms of quality-adjusted life-years. Irrespective of income, moderate drinkers were little affected by a minimum unit price of £0.45 in our model, with the greatest effects noted for harmful drinkers. Because harmful drinkers on low incomes purchase more alcohol at less than the minimum unit price threshold compared with other groups, they would be affected most by this policy. Large reductions in consumption in this group would however coincide with substantial health gains in terms of morbidity and mortality related to reduced alcohol consumption. UK Medical Research Council and Economic and Social Research Council (grant G1000043). Copyright © 2014 Holmes et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd. All rights reserved.

Modeling per capita state health expenditure variation: state-level characteristics matter.

PubMed

Cuckler, Gigi; Sisko, Andrea

2013-01-01

In this paper, we describe the methods underlying the econometric model developed by the Office of the Actuary in the Centers for Medicare & Medicaid Services, to explain differences in per capita total personal health care spending by state, as described in Cuckler, et al. (2011). Additionally, we discuss many alternative model specifications to provide additional insights for valid interpretation of the model. We study per capita personal health care spending as measured by the State Health Expenditures, by State of Residence for 1991-2009, produced by the Centers for Medicare & Medicaid Services' Office of the Actuary. State-level demographic, health status, economic, and health economy characteristics were gathered from a variety of U.S. government sources, such as the Census Bureau, Bureau of Economic Analysis, the Centers for Disease Control, the American Hospital Association, and HealthLeaders-InterStudy. State-specific factors, such as income, health care capacity, and the share of elderly residents, are important factors in explaining the level of per capita personal health care spending variation among states over time. However, the slow-moving nature of health spending per capita and close relationships among state-level factors create inefficiencies in modeling this variation, likely resulting in incorrectly estimated standard errors. In addition, we find that both pooled and fixed effects models primarily capture cross-sectional variation rather than period-specific variation.

Modeling Per Capita State Health Expenditure Variation: State-Level Characteristics Matter

PubMed Central

Cuckler, Gigi; Sisko, Andrea

2013-01-01

Objective In this paper, we describe the methods underlying the econometric model developed by the Office of the Actuary in the Centers for Medicare & Medicaid Services, to explain differences in per capita total personal health care spending by state, as described in Cuckler, et al. (2011). Additionally, we discuss many alternative model specifications to provide additional insights for valid interpretation of the model. Data Source We study per capita personal health care spending as measured by the State Health Expenditures, by State of Residence for 1991–2009, produced by the Centers for Medicare & Medicaid Services’ Office of the Actuary. State-level demographic, health status, economic, and health economy characteristics were gathered from a variety of U.S. government sources, such as the Census Bureau, Bureau of Economic Analysis, the Centers for Disease Control, the American Hospital Association, and HealthLeaders-InterStudy. Principal Findings State-specific factors, such as income, health care capacity, and the share of elderly residents, are important factors in explaining the level of per capita personal health care spending variation among states over time. However, the slow-moving nature of health spending per capita and close relationships among state-level factors create inefficiencies in modeling this variation, likely resulting in incorrectly estimated standard errors. In addition, we find that both pooled and fixed effects models primarily capture cross-sectional variation rather than period-specific variation. PMID:24834363

Health care reform and the pharmaceutical industry: crucial decisions are expected.

PubMed

Liberman, Aaron; Rubinstein, Jason

2002-03-01

For the past 30 years, the largest growing segment of the United States economy is the health care industry. The United States is in a transitional period as American citizens born between 1946 and 1964, the Baby Boomer generation, reach retirement age. In recent years, pharmaceutical costs have been rising faster than the inflation rate, leaving the American public to ask many questions. A major area of interest to policymakers regarding the health care reform agenda is patient spending on pharmaceutical items. Government-funded programs such as Medicare and Medicaid are facing the possibility of running out of funds and require substantive reform. Pharmaceuticals are not covered under the basic Medicare programs. As a result, senior citizens are forced to cover their prescription expenses out of pocket or purchase supplemental insurance plans. This extra expense is leaving many senior citizens across the country struggling to support their ongoing medical needs.

The Impact of an Aging Population in the Workplace.

PubMed

White, Mercedia Stevenson; Burns, Candace; Conlon, Helen Acree

2018-03-01

According to the Centers for Disease Control and Prevention, the number of people 65 years of age or older living in the United States is projected to double by 2030 to 72 million adults, representing 20% of the total U.S. Evidence suggests that older Americans are working longer and spending more time on the job than their peers did in previous years. The increased number of older adults working longer is observed not only in the Unites States but also worldwide. There are numerous ramifications associated with the changing demographics and the expanding prevalence of an aging population in the workforce. Dynamics that arise include stereotyping and discrimination, longevity and on-site expert knowledge, variances in workplace behavior, a multigenerational employee pool, chronic disease management, occupational safety, and the application of adaptive strategies to reduce injury occurrences. Occupational health nurses play a pivotal role in implementing best practices for an aging-friendly workplace.

DataView: Medicare Spending by State: The Border-Crossing Adjustment

PubMed Central

Basu, Joy; Lazenby, Helen C.; Levit, Katharine R.

1995-01-01

As the first step in a pioneering effort by the Health Care Financing Administration (HCFA) to measure interstate border crossing for services used by both Medicare and non-Medicare beneficiaries, the authors study the spending behavior of Medicare beneficiaries for 10 Medicare-covered services. Based on interstate flow-of-expenditure data developed for calendar year 1991, the authors analyze the spending patterns of State residents by studying the inflow and outflow rates and the net flow ratios of expenditures incurred by Medicare patients. The report also provides per capita expenditure estimates with residence-based adjustments and evaluates the impact of the border-crossing adjustment for individual services and States. PMID:10157375

Schools Feel Pressure of Efforts to Increase Fiscal Accountability

ERIC Educational Resources Information Center

Hoff, David J.

2005-01-01

With systems of accountability for student achievement now widely in place, state policymakers and others are applying the principle on another front by trying to hold schools more responsible for how they spend their money. Auditors in some states regularly calculate the percentages that districts spend on classroom resources compared with…

State of the States in Developmental Disabilities: 2004

ERIC Educational Resources Information Center

Braddock, David; Hemp, Richard; Rizzolo, Mary C.

2004-01-01

Public spending for MR/DD services grew rapidly during FYs 2000-2002. This rapid growth was followed by reductions in spending for MR/DD services as the nation's economy declined during 2002-2004. However, convergent factors stimulating future expansion of funding and services for persons with MR/DD include rapidly expanding cohorts of aging…

Evaluating the medical malpractice system and options for reform.

PubMed

Kessler, Daniel P

2011-01-01

The U.S. medical malpractice liability system has two principal objectives: to compensate patients who are injured through the negligence of healthcare providers and to deter providers from practicing negligently. In practice, however, the system is slow and costly to administer. It both fails to compensate patients who have suffered from bad medical care and compensates those who haven't. According to opinion surveys of physicians, the system creates incentives to undertake cost-ineffective treatments based on fear of legal liability--to practice "defensive medicine." The failures of the liability system and the high cost of health care in the United States have led to an important debate over tort policy. How well does malpractice law achieve its intended goals? How large of a problem is defensive medicine and can reforms to malpractice law reduce its impact on healthcare spending? The flaws of the existing system have led a number of states to change their laws in a way that would reduce malpractice liability--to adopt "tort reforms." Evidence from several studies suggests that wisely chosen reforms have the potential to reduce healthcare spending significantly with no adverse impact on patient health outcomes.

Understanding dual enrollees' use of Medicare home health services: the effects of differences in Medicaid home care programs.

PubMed

Kenney, G; Rajan, S

2000-01-01

Both the Medicare and Medicaid programs have experienced considerable growth in spending on home care in recent years. As policymakers adopt measures (such as those legislated in the Balanced Budget Act of 1997) to curb the rate of spending growth on home care services, it is important to understand interactions between the Medicare and Medicaid home care programs in serving the dually enrolled population. This study examines the potential effects of the Medicaid home care program on Medicare home health utilization using multivariate models. The study relied on data from the Health Care Financing Administration's Medicare Current Beneficiary Survey (MCBS), a longitudinal survey of Medicare enrollees. The primary MCBS file used was from Round 1 of the survey, which was fielded between September and December 1991. The unit of analysis was individuals. The authors used descriptive and multivariate methods to explore the relationship between Medicare coverage and state home care program characteristics. Included were variables that have been found to be significant determinants of Medicare home health utilization in other studies as well as variables to indicate the availability and generosity of Medicaid home care services in each state represented in the survey. The findings were consistent with those of previous studies, in that dual enrollees were disproportionate users of Medicare home health services, accounting for only 16% of enrollees but receiving 40% of all visits. In addition, lower levels of Medicare home health use were observed in states with relatively higher Medicaid spending on home health and personal care services, but this relationship appeared to be heavily dominated by the inclusion of enrollees living in New York State. When individuals from New York were excluded from the analysis, we found a negative but statistically significant relationship between Medicaid outlays on home health and personal care services and Medicare home health utilization. Because the Medicare and Medicaid programs are interconnected through the sizable dual enrollee population, changes in one program are likely to have ramifications for the other. This study presents another step in exploring how the two programs interact and emphasizes the fact that costs can be shifted between the two programs as policy changes are made to control the rate of home care spending growth.

Hospital Advertising, Competition, and HCAHPS: Does It Pay to Advertise?

PubMed

Huppertz, John W; Bowman, R Alan; Bizer, George Y; Sidhu, Mandeep S; McVeigh, Colleen

2017-08-01

To test whether hospital advertising expenditures predict HCAHPS global ratings. We examined media advertising expenditures by 2,142 acute care hospitals in 209 markets in the United States. Data on hospital characteristics, location, and revenue came from CMS reports; system ownership was obtained from the American Hospital Association. Advertising data came from Kantar Media. HCAHPS data were obtained from HospitalCompare. Regression models examined whether hospitals' advertising spending predicts HCAHPS global measures and whether market concentration moderated this association. Hospital advertising spending was calculated by adding each individual hospital's expenditures to the amount spent by its parent health system, proportionally allocated by hospital revenue. Health system market share was used to estimate market concentration. These data were compared to hospitals' HCAHPS measures. In competitive markets (HHI below 1,000), hospital advertising predicted HCAHPS global measures. A 1-percent increase in advertising was associated with a 1.173-percent increase in patients rating the hospital a "9" or "10" on the HCAHPS survey and a 1.540-percent increase in patients who "definitely" would recommend the hospital. In concentrated markets, this association was not significant. In competitive markets, hospitals that spend more on advertising earn higher HCAHPS ratings on global measures. © Health Research and Educational Trust.

Teaching about the Holocaust--A Resource Guide

ERIC Educational Resources Information Center

Russell, William Benedict, III

2005-01-01

Teaching about the Holocaust is an emotional process that can be extremely difficult, especially without the proper resources. Most teachers spend one or two class periods on the Holocaust and usually cram the lesson into a unit on World War II. As a teacher, the author understands that time is short and that it is impossible to spend the…

An Exploratory Analysis of the U.S. System of Major Defense Acquisition Utilizing the CLIOS Process

DTIC Science & Technology

2009-09-01

SPENDING COUNTRIES .............................................20 1. The United States’ Defense Acquisition System..............................21 2...Improvement Initiatives ...............................................................20 Table 4. The Top 15 Military Spender Countries in 2008...other top military spending countries . It will end with a review of the major defense acquisition literature. This literature review will focus on

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

PubMed

Yoon, Jangho; Luck, Jeff

2016-12-01

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

Reassessing the Security Treaty Between Australia, New Zealand, and the United States (ANZUS): Post-Cold War Security Relations

DTIC Science & Technology

1998-01-01

Zealand in the World Since 1945 ( Auckland , New Zealand: 1975), 25. 23 Keith Sinclair, 31. 24 T.B. Millar, 221. 25 T.B. Millar, 143. 26 T.B...outrage that spilled over into anti-nuclear opinion. Further fuel to the fire was that the bombing had taken place inside the port of Auckland ; New...superficially seems to do in pure monetary terms but the purported increase in spending “…would not raise the proportion of the nation’s GDP , but would

Demographics, political power and economic growth.

PubMed

Holtz-eakin, D

1993-01-01

"Growth theory may be used to predict the response of saving, capital formation, and output growth to large demographic shifts. Such large shifts would also be expected to alter the demand for government services and the desired levels of taxation in the population. This paper extends the overlapping-generations model of economic growth to predict the evolution of government tax and spending policy through the course of a major demographic shift. Simulations suggest that this approach may yield valuable insights into the evolution of policy in the United States and other industrialized economies." excerpt

National health expenditures projections through 2030

PubMed Central

Burner, Sally T.; Waldo, Daniel R.; McKusick, David R.

1992-01-01

If current laws and practices continue, health expenditures in the United States will reach $1.7 trillion by the year 2000, an amount equal to 18.1 percent of the Nation's gross domestic product (GDP). By the year 2030, as America's baby boomers enter their seventies and eighties, health spending will top $16 trillion, or 32 percent of GDP. The projections presented here incorporate the assumptions and conclusions of the Medicare trustees in their 1992 report to Congress on the status of Medicare, and the 1992 President's budget estimates of Medicaid outlays. PMID:10124432

End-preparation assessments and tests for compounded sterile preparations.

PubMed

McElhiney, Linda F

2013-01-01

Outsourcing has become a necessity to obtain sterile products that are currently on backorder. Because of the expense of outsourcing sterile compounding, pharmacy leadership in health systems are now considering the option of insourcing and batch preparing compounded sterile preparations, which can be a viable option for a health system. It can significantly decrease drug-spending costs, and the pharmacy has a complete record of the compounding process. The key to preparing high-quality, safe, sterile preparations and meeting United States Pharmacopeia standards is end-preparation assessments and tests.

Defense Policy and Low-Intensity Conflict. The Development of Britain’s ’Small Wars’ Doctrine During the 1950s

DTIC Science & Technology

1991-01-01

United States was spending as a pro- portion of its national income. Ibid., p. 52. 5William Wallace, "World Status Without Tears," in Bogdanor and... Bogdanor , Vernon, and Robert Skidelsky (eds.), The Age of Affluence, 1951-1964, Macmillan, London, 1970. Bowie, Robert R., Suez 1956, Oxford...1986. Wallace, William, "World Status Without Tears," in Bogdanor and Skidelsky, 1970., Wolffe, Jim, "Powell Rejects Plan to Loosen Special Operations Leash," The Army Times, 16 July 1990, p. 12.

Occupational Alcoholism Programs Under Federal Contracts, 1978; Joint Hearing Before the Subcommittee on Alcoholism and Drug Abuse of the Committee on Human Resources and the Subcommittee on Federal Spending Practices and Open Government of the Committee on Governmental Affairs, United States Senate, Ninety-Fifth Congress, Second Session on S. 2525.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. Senate Committee on Human Resources.

These hearings, representing the testimony before the Subcommittee on Alcoholism and Drug Abuse in August, 1978, sought to require government contractors to establish and operate alcohol abuse and alcoholism programs and services, or to arrange for referral to such services. Statements are included from witnesses representing such agencies as the…

Working at the Weekend: Fathers' Time with Family in the United Kingdom.

PubMed

Hook, Jennifer L

2012-08-01

Whereas most resident fathers are able to spend more time with their children on weekends than on weekdays, many fathers work on the weekends spending less time with their children on these days. There are conflicting findings about whether fathers are able to make up for lost weekend time on weekdays. Using unique features of the United Kingdom's National Survey of Time Use 2000 (UKTUS) I examine the impact of fathers' weekend work on the time fathers spend with their children, family, and partners (N = 595 fathers). I find that weekend work is common among fathers and is associated with less time with children, families, and partners. Fathers do not recover lost time with children on weekdays, largely because weekend work is a symptom of overwork. Findings also reveal that even if fathers had compensatory time, they are unlikely to recover lost time spent as a family or couple.

Working at the Weekend: Fathers’ Time with Family in the United Kingdom

PubMed Central

Hook, Jennifer L.

2012-01-01

Whereas most resident fathers are able to spend more time with their children on weekends than on weekdays, many fathers work on the weekends spending less time with their children on these days. There are conflicting findings about whether fathers are able to make up for lost weekend time on weekdays. Using unique features of the United Kingdom’s National Survey of Time Use 2000 (UKTUS) I examine the impact of fathers’ weekend work on the time fathers spend with their children, family, and partners (N = 595 fathers). I find that weekend work is common among fathers and is associated with less time with children, families, and partners. Fathers do not recover lost time with children on weekdays, largely because weekend work is a symptom of overwork. Findings also reveal that even if fathers had compensatory time, they are unlikely to recover lost time spent as a family or couple. PMID:22844157

Single European currency and Monetary Union. Macroeconomic implications for pharmaceutical spending.

PubMed

Kanavos, P

1998-01-01

This article examines the potential implications of introducing a single currency among the Member States of the European Union for national pharmaceutical prices and spending. In doing so, it provides a brief account of the direct effects of introducing a single currency on pharmaceutical business. These are static in nature and include the elimination of exchange rate volatility and transaction costs, increased price transparency and limited potential for parallel trade. It subsequently analyses the potential medium and long term macroeconomic policy choices facing the Member States and their impact on pharmaceutical spending following the introduction of a single currency. These include policy directions in order to meet the Maastricht convergence criteria in the run-up to forming an Economic and Monetary Union (EMU) and the implications of EMU on national macroeconomic policy thereafter. This article argues that the necessity for tight fiscal policies across the EU and, in particular, in those Member States facing high budget deficits and overall debt levels, will continue to exert considerable downward pressure on pharmaceutical spending.

Iran's growing nuclear weapons program: A catalyst for regional instability in the Middle East. Study project

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

Deyermond, J.J.

1993-03-10

Following the end of the Cold War, the United States as well as other nations around the world now find themselves in a state of political, economic, and military transition. While the US and other nations such as the Islamic Republic of Iran are undergoing significant increases in military spending. This increase has been primarily in the area of conventional forces, however there is growing evidence that Iran is also attempting to develop a nuclear weapons capability as well. This study examines Iran's nuclear weapons program in detail, and Tehran's increasing ability to emerge as a regional power in themore » Middle East.« less

Economic Impact of Pacific Northwest National Laboratory on the State of Washington in Fiscal Year 2013

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

Scott, Michael J.; Niemeyer, Jackie M.

Pacific Northwest National Laboratory (PNNL) is a large economic entity, with $1.06 billion in annual funding, $936 million in total spending, and 4,344 employees in fiscal year (FY) 2013. Four thousand, one hundred and one (4,101) employees live in Washington State. The Laboratory directly and indirectly supports almost $1.31 billion in economic output, 6,802 jobs, and $514 million in Washington State wage income from current operations. The state also gains more than $1.21 billion in output, more than 6,400 jobs, and $459 million in income through closely related economic activities, such as visitors, health care spending, spending by resident retirees,more » and spinoff companies. PNNL affects Washington’s economy through commonly recognized economic channels, including spending on payrolls and other goods and services that support Laboratory operations. Less-commonly recognized channels also have their own impacts and include company-supported spending on health care for its staff members and retirees, spending of its resident retirees, Laboratory visitor spending, and the economic activities in a growing constellation of “spinoff” companies founded on PNNL research, technology, and managerial expertise. PNNL also has a significant impact on science and technology education and community nonprofit organizations. PNNL is an active participant in the future scientific enterprise in Washington with the state’s K-12 schools, colleges, and universities. The Laboratory sends staff members to the classroom and brings hundreds of students to the PNNL campus to help train the next generation of scientists, engineers, mathematicians, and technicians. This investment in human capital, though difficult to measure in terms of current dollars of economic output, is among the important lasting legacies of the Laboratory. Finally, PNNL contributes to the local community with millions of dollars’ worth of cash and in-kind corporate and staff contributions, all of which strengthen the economy. This report quantifies these effects, providing detailed information on PNNL’s revenues and expenditures, as well as the impacts of its activities on the rest of the Washington State economy. This report also describes the impacts of the four closely related activities: health care spending, spinoff companies with roots in PNNL, visitors to the Laboratory, and PNNL retirees.« less

Florida's Past and Future Roles in Education Finance Reform Litigation

ERIC Educational Resources Information Center

Bauries, Scott R.

2006-01-01

The state of Florida has since the time of "San Antonio v. Rodriguez" an education finance system called the Florida Education Finance Plan (FEFP), which makes substantial effort to equalize per-pupil spending in all of the state's school districts, while recognizing the local factors that may necessitate changes in that spending. Still,…

The Determinants of State Spending on Higher Education: How Capital Project Funding Differs from General Fund Appropriations

ERIC Educational Resources Information Center

Ness, Erik C.; Tandberg, David A.

2013-01-01

Our fixed-effects panel data analysis of state spending on higher education fills a near void of studies examining capital expenditures on higher education. In our study, we found that political characteristics (e.g., interest group activity, organizational structure, and formal powers) largely account for differences between general fund and…

Colleges Must Face Reality and Recognize Opportunity in the Economic Downturn

ERIC Educational Resources Information Center

Knecht, Ron

2009-01-01

Because of the worst economic downturn since World War II, many state governments now expect revenues to fall in coming years--resulting in less public spending on higher education. Certain state-revenue reforms could moderate the effects of economic slumps on colleges. In this article, the author examines the growth of public spending on…

Energy efficiency opportunities in the brewery industry

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

Worrell, Ernst; Galitsky, Christina; Martin, Nathan

2002-06-28

Breweries in the United States spend annually over $200 Million on energy. Energy consumption is equal to 3-8% of the production costs of beer, making energy efficiency improvement an important way to reduce costs, especially in times of high energy price volatility. After a summary of the beer making process and energy use, we examine energy efficiency opportunities available for breweries. We provide specific primary energy savings for each energy efficiency measure based on case studies that have implemented the measures, as well as references to technical literature. If available, we have also listed typical payback periods. Our findings suggestmore » that there may still be opportunities to reduce energy consumption cost-effectively for breweries. Major brewing companies have and will continue to spend capital on cost effective measures that do not impact the quality of the beer. Further research on the economics of the measures, as well as their applicability to different brewing practices, is needed to assess implementation of selected technologies at individual breweries.« less

Differences in health care spending across countries: statistical evidence.

PubMed

Pfaff, M

1990-01-01

The empirical evidence available for OECD countries suggests that economic factors play a major role and that demographic factors play a minor role in explaining differences in health care spending across countries. When countries are grouped on the basis of their health care systems, some significant cross-country differences result: countries with higher transfer rates (a larger share of collective financing) are not generally characterized by higher health care expenditures, and conversely, countries with a larger share of private financing (including higher coinsurance rates) do not have lower expenditures. Rather, the opposite holds true. Similar conclusions apply to the share of public versus private production of health goods. Furthermore, the results do not support the claims of those critics of universal public insurance systems who consider the expansion of the coverage to be a major source of expenditure growth. These findings cast serious doubt on the claim that cost containment can be achieved via market reforms that rely heavily on direct consumer payments and cost sharing as instruments of financing. A comparative analysis of the historic record of the United States, Canada, and the Federal Republic of Germany generally supports these conclusions; it also suggests that a greater degree of public penetration offers a better chance for control of health spending, particularly in periods of austerity. There is a strong presumption that health care systems relying on some overall control of spending generally are more cost-effective than those relying more on decentralized mechanisms of control. Services are more equitably distributed in relation to health and payment for health services is far more progressive in the former type of system.

Welfare Reform: States Provide TANF-Funded Services to Many Low-Income Families Who Do Not Receive Cash Assistance. Report to the Ranking Minority Member, Subcommittee on Human Resources, Committee on Ways and Means, House of Representatives.

ERIC Educational Resources Information Center

Fagnoni, Cynthia M.; Posner, Paul L.

A study determined the extent to which states spend federal Temporary Assistance for Needy Families (TANF) and state maintenance-of-effort (MOE) funds for cash assistance and non-cash services and how this compares to welfare spending in fiscal year (FY) 1995. It also identifed the extent to which states use TANF and MOE funds to provide services…

Assessing the Impact of Regeneration Spending: Lessons from the United Kingdom and the Wider World

ERIC Educational Resources Information Center

Potts, David

2008-01-01

The government increased the funding for regional development agencies to 2.3 billion British Pounds in 2007/8, yet hard evidence on the effectiveness of the spending is difficult to find. Techniques for valuing benefits in difficult areas have existed for many years. They range from the hedonic methods and contingent valuation studies of…

Working on the Weekend: Fathers' Time with Family in the United Kingdom

ERIC Educational Resources Information Center

Hook, Jennifer L.

2012-01-01

Whereas most resident fathers are able to spend more time with their children on weekends than on weekdays, many fathers work on the weekends, spending less time with their children on these days. There are conflicting findings about whether fathers are able to make up for lost weekend time on weekdays. Using unique features of the United…

The Cost of Protecting Vulnerable Children II: What Has Changed Since 1996? Occasional Paper Number 46. Assessing the New Federalism: An Urban Institute Program To Assess Changing Social Policies.

ERIC Educational Resources Information Center

Bess, Roseanna; Leos-Urbel, Jacob; Geen, Rob

Given recent changes to child welfare financing brought about by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, there is a need to track spending for child welfare services. This report documents states' total child welfare spending from federal, state, and local sources in state fiscal year (SFY) 1998; changes in…

State-Level Community Benefit Regulation and Nonprofit Hospitals' Provision of Community Benefits.

PubMed

Singh, Simone R; Young, Gary J; Loomer, Lacey; Madison, Kristin

2018-04-01

Do nonprofit hospitals provide enough community benefits to justify their tax exemptions? States have sought to enhance nonprofit hospitals' accountability and oversight through regulation, including requirements to report community benefits, conduct community health needs assessments, provide minimum levels of community benefits, and adhere to minimum income eligibility standards for charity care. However, little research has assessed these regulations' impact on community benefits. Using 2009-11 Internal Revenue Service data on community benefit spending for more than eighteen hundred hospitals and the Hilltop Institute's data on community benefit regulation, we investigated the relationship between these four types of regulation and the level and types of hospital-provided community benefits. Our multivariate regression analyses showed that only community health needs assessments were consistently associated with greater community benefit spending. The results for reporting and minimum spending requirements were mixed, while minimum income eligibility standards for charity care were unrelated to community benefit spending. State adoption of multiple types of regulation was consistently associated with higher levels of hospital-provided community benefits, possibly because regulatory intensity conveys a strong signal to the hospital community that more spending is expected. This study can inform efforts to design regulations that will encourage hospitals to provide community benefits consistent with policy makers' goals. Copyright © 2018 by Duke University Press.

The Tithing of Higher Education, Out-of-Pocket Spending by Faculty. A Research Report.

ERIC Educational Resources Information Center

Maury, Kathleen; And Others

This study was done to determine how much faculty in the Minnesota State University System spend out of their own pocket to support their work. A survey was distributed to all system faculty (n=2,370) and included demographic and spending pattern items as well as open-ended items. Seven hundred and eleven surveys were returned. Results indicated…

A portrait of interventional radiologists in the United States.

PubMed

Sunshine, Jonathan H; Lewis, Rebecca S; Bhargavan, Mythreyi

2005-11-01

In recognition of the emergence of interventional radiology as an important "new component of...radiology," the objective of our study was to provide an extensive and detailed portrait of interventional radiologists, their professional activities, and the practices in which they work. We tabulated data from the American College of Radiology's 2003 Survey of Radiologists, a stratified random-sample survey that oversampled interventionalists and achieved a 63% response rate with a total of 1,924 responses. Responses were weighted to make them representative of all radiologists in the United States. We compared information about interventionalists with that for other radiologists. Depending on the definition of who is an interventionalist, 8.5-11.5% of radiologists are interventionalists. By most definitions, only slightly under half of interventionalists spend 70% or more of their clinical work time performing interventional procedures. Interventionalists work, on average, 56-58 hr weekly, a few hours longer than other radiologists. The average interventionalist performs procedures in five of the seven categories of procedures into which we divided interventional radiology, compared with one or two categories for other radiologists. The average interventionalist performs procedures in five of the seven broad categories (such as MRI, CT, and nuclear medicine) into which we divided all of radiology, much the same breadth of practice as other subspecialists and also as nonsubspecialists. Interventionalists have become a sizable group within radiology. They are in some ways like other radiologists and in other ways different, but they do not spend as much of their time in their subspecialty as some assume and, overall, are not as different.

Child Care: States Increased Spending on Low-Income Families. Report to Congressional Requesters.

ERIC Educational Resources Information Center

Shaul, Marnie S.

Recognition of the link between child care and the success of welfare reform has given rise to questions about how states are spending child care funds provided through Temporary Assistance to Needy Families (TANF) and the Child Care and Development Fund (CCDF). At the request of members of Congress, this report from the General Accounting Office…

Fathers’ Leave and Fathers’ Involvement: Evidence from Four OECD Countries

PubMed Central

Huerta, Maria C.; Adema, Willem; Baxter, Jennifer; Han, Wen-Jui; Lausten, Mette; Lee, RaeHyuck; Waldfogel, Jane

2016-01-01

In recent years, several OECD countries have taken steps to promote policies encouraging fathers to spend more time caring for young children, thereby promoting a more gender equal division of care work. Evidence, mainly for the United States and United Kingdom, has shown fathers taking some time off work around childbirth are more likely to be involved in childcare related activities than fathers who do not take time off. This paper conducts a first cross-national analysis on the association between fathers’ leave taking and fathers’ involvement when children are young. It uses birth cohort data of children born around 2000 from four OECD countries: Australia, Denmark, the United Kingdom and the United States. Results show that the majority of fathers take time off around childbirth independent of the leave policies in place. In all countries, except Denmark, important socio-economic differences between fathers who take leave and those who do not are observed. In addition, fathers who take leave, especially those taking two weeks or more, are more likely to carry out childcare related activities when children are young. This study adds to the evidence that suggests that parental leave for fathers is positively associated with subsequent paternal involvement. PMID:28479865

Medicaid policy and the substitution of hospital outpatient care for physician care.

PubMed

Cohen, J W

1989-04-01

This article explores the effects of reimbursement and utilization control policies on utilization patterns and spending for physician and hospital outpatient services under state Medicaid programs. The empirical work shows a negative relationship between the level of Medicaid physician fees relative to Medicare and private fees, and the numbers of outpatient care recipients, suggesting that outpatient care substitutes for physician care in states with low fee levels. In addition, it shows a positive relationship between Medicaid physician fees and outpatient spending per recipient, suggesting that in low-fee states outpatient departments are providing some types of care that could be provided in a physician's office. Finally, the analysis demonstrates that reimbursement and utilization control policies have significant effects in the expected directions on aggregate Medicaid spending for physician and outpatient services.

[Private spending on oral health in Brazil: analysis of data from the Family Budgets Survey, 2008-2009].

PubMed

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

2017-12-01

The aim was to analyze Brazilians' private spending on dental care and oral hygiene products. Data were analyzed from 55,970 households in the Family Budgets Survey, 2008-2009. Expenditures were analyzed by major geographic region, state, state capital, and household socioeconomic and demographic characteristics (sex, age, head-of-household's skin color and schooling, per capita household income, and presence of elderly in the household). Brazilians spent an average of BRL 42.19 per year on dental care and BRL 10.27 on oral hygiene products. The study detected social inequalities in the distribution of these expenditures according to household residents' characteristics and the different geographic regions, states, and state capitals. The current study evidenced quantitative and specific details on Brazilians' spending on dental care and oral hygiene products. Monitoring and assessment of these expenditures are fundamental for evaluating and orienting public policies in oral health.

Time Investment and Time Management: An Analysis of Time Students Spend Working at Home for School

ERIC Educational Resources Information Center

Wagner, Petra; Schober, Barbara; Spiel, Christiane

2008-01-01

This paper deals with the time students spend working at home for school. In Study 1, we investigated amount and regulation of time. Study 2 serves to validate the results of Study 1 and, in addition, investigates the duration of the time units students used and their relation to scholastic success. In Study 1, the participants were 332 students…

Personal Health Care Expenditures by State, Selected Years 1966-1978

PubMed Central

Levit, Katharine R.

1982-01-01

In 1966, spending for personal health care in the U.S. was $39 billion. By 1978, these expenditures had grown to $166 billion. Among regions and states, different patterns and levels of spending emerged, along with different rates of growth. Some of the highlights from the accompanying report which pinpoint personal health care spending differences among regions and states are listed below. In 1978, $745 per person was spent for personal health care services within the U.S. Massachusetts led the nation in spending with $935 per person. The lowest spending for personal health—$521 per capita—occurred in South Carolina.Expenditures for hospital care ranged from a high of $490 per capita in Massachusetts to a low of $197 per capita in Idaho, with the U.S. expenditure level at $337 per person.Spending for physician services in 1978 was $161 per person nationwide. The highest level of spending—$238—was in California, and the lowest—$90—was in Vermont. Florida, with the largest proportion of aged residents in the U.S., registered expenditure levels of $208 per person for physician services. Despite a 29.5 percent increase nationwide in the number of physicians from 1969 to 1978, little change has occurred in the rank of states and regions in their physician-to-population concentrations.Minnesota led the nation in nursing home care expenditures, spending $126 per person for this service in 1978. Minnesota's high per capita spending for nursing home care correlates with its large number of nursing home beds per 65 years of age and over population. In 1978, the 96 beds per 1000 elderly residents which were maintained in Minnesota contrasted sharply with the 56 beds maintained per 1000 elderly residents nationwide.Personal health care expenditures per capita grew an average of 11.6 percent per year between 1966 and 1978. Growth was most dramatic in the Southeast, where expenditures per capita more than quadrupled, growing 12.6 percent per year. Mississippi registered an average annual growth rate of 14.0 percent to lead the region and the nation in rate of increase in per capita personal health care spending growth. The region with the smallest rate of increase in personal health expenditures per capita was the Rocky Mountain Region with an average annual growth of 10.4 percent between 1966 and 1978. Wyoming registered the slowest growth in personal health care expenditures per capita in that region and the nation, with 8.9 percent average annual growth.Expenditures for personal health care in states and regions have grown at different rates. However, when the effects of population and the changing age structure of a geographic area are removed, much of the variation disappears. PMID:10309908

More Freedom to Spend Less Money: What Happened when California School Districts Gained Spending Flexibility and Budgets Were Cut. Research Brief

ERIC Educational Resources Information Center

Li, Jennifer

2012-01-01

In 2009-2010, California made substantial education budget cuts at the same time that it removed its spending requirements from $4.5 billion of state money. This gave districts the flexibility to use the funds in any manner approved by the local school board. Researchers found that most of the formerly earmarked money was moved into general funds…

Spending controls cited as reasons for decline in health care cost hikes.

PubMed

2005-04-01

Data Insight: Health care spending in the U.S. grew 7.7% in 2003, down from 9.3% in 2002, marking the first decline in costs in seven years, according to a report by the Centers for Medicare & Medicaid Services Office of the Actuary. CMS economists say spending declined because state Medicaid programs cut budgets and became more efficient through the use of managed care.

How the ACA's Health Insurance Expansions Have Affected Out-of-Pocket Cost-Sharing and Spending on Premiums.

PubMed

Glied, Sherry; Solís-Román, Claudia; Parikh, Shivani

2016-09-01

One important benefit gained by the millions of Americans with health insurance through the Affordable Care Act (ACA) is protection from high out-of-pocket health spending. While Medicaid unambiguously reduces out-of-pocket premium and medical costs for low-income people, it is less certain that marketplace coverage and other types of insurance purchased to comply with the law's individual mandate also protect from high health spending. Goal: To compare out-of-pocket spending in 2014 to spending in 2013; assess how this spending changed in states where many people enrolled in the marketplaces relative to states where few people enrolled; and project the decline in the percentage of people paying high amounts out-of-pocket. Methods: Linear regression models were used to estimate whether people under age 65 spent above certain thresholds. Key findings and conclusions: The probability of incurring high out-of-pocket costs and premium expenses declined as marketplace enrollment increased. The percentage reductions were greatest among those with incomes between 250 percent and 399 percent of poverty, those who were eligible for premium subsidies, and those who previously were uninsured or had very limited nongroup coverage. These effects appear largely attributable to marketplace enrollment rather than to other ACA provisions or to economic trends.

The Impact of Advanced Placement Incentive Programs. Education Policy Brief. Volume 8, Number 1, Winter 2010

ERIC Educational Resources Information Center

Holstead, Michael S.; Spradlin, Terry E.; McGillivray, Margaret E.; Burroughs, Nathan

2010-01-01

In December of 2009, Indiana Governor Mitch Daniels announced that the latest state revenue forecasts predict that the state of Indiana will spend $1.8 billion more than it receives in tax revenue collections through July 2011. Therefore, Governor Daniels announced that he will cut at least $300 million from K-12 education spending in the next…

Projection of Minnesota State Grant Spending for Fiscal Years 2004 and 2005. July 15, 2004.

ERIC Educational Resources Information Center

Minnesota Higher Education Services Office, 2004

2004-01-01

This report is one of the quarterly projections on Minnesota State Grant spending required by the Legislature. The July 15th report is important in that it is the one with the most complete data to make rationing estimates and decisions for the fall term. It includes the following: (1) an overview of how the Higher Education Services Office…

How Can School Funding Increase If Operating Budgets Are Declining? Get the Facts... #2

ERIC Educational Resources Information Center

Kansas Association of School Boards (NJ1), 2012

2012-01-01

State and local funding for general operating budgets for Kansas public schools will be at a five-year low this school year, yet total Kansas school district spending will reach an all-time high of $5.67 billion according to estimates released by the Kansas State Department of Education. Total per pupil spending is projected to reach $12,454 per…

Resource allocation for pharmaceutical procurement in the Brazilian Unified Health System.

PubMed

Vieira, Fabiola Sulpino; Zucchi, Paola

2011-10-01

To analyze resource allocation for pharmaceutical procurement by federative entities in the Brazilian Unified Health System. The amounts allocated to purchase pharmaceuticals during 2009 in two information systems were analyzed: Siga Brasil (Follow Brazil) for national data and Sistema de Informações sobre Orçamentos Públicos em Saúde (Information System on Public Health Budgets) for states, the Federal District and municipalities data. Per capita spending and the mean and median spending were calculated by municipalities, according to region and population size. The Spearman correlation coefficient was calculated for some variables. The statistical analysis included tests of normality and multiple comparisons for differences between groups. In 2009 the total amount spent by the three spheres of government for purchase of medicines was approximately R$ 8.9 billion. States and the Federal District were the main players, accounting for 47.1% of the total amount spent in the health system. Some states had per capita spending well above the mean (R$ 22.00 per resident/year) and the median (R$ 17.00 per resident/year). There were differences in municipal spending by region. The mean per capita expenditure of municipalities with less than 5,000 residents was 3.9 times that of municipalities with over 500,000 residents. Municipalities with less than 10,000 residents had higher per capita spending than other municipalities. Economic aspects such as the scale of procurement and bargaining power may explain differences in per capita spending between federal entities, especially among municipalities. The study indicates inefficiencies in the use of financial resources to procure medicines in the Brazilian Unified Health System.

Geographic variation in public health spending: correlates and consequences.

PubMed

Mays, Glen P; Smith, Sharla A

2009-10-01

To examine the extent of variation in public health agency spending levels across communities and over time, and to identify institutional and community correlates of this variation. Three cross-sectional surveys of the nation's 2,900 local public health agencies conducted by the National Association of County and City Health Officials in 1993, 1997, and 2005, linked with contemporaneous information on population demographics, socioeconomic characteristics, and health resources. A longitudinal cohort design was used to analyze community-level variation and change in per-capita public health agency spending between 1993 and 2005. Multivariate regression models for panel data were used to estimate associations between spending, institutional characteristics, health resources, and population characteristics. The top 20 percent of communities had public health agency spending levels >13 times higher than communities in the lowest quintile, and most of this variation persisted after adjusting for differences in demographics and service mix. Local boards of health and decentralized state-local administrative structures were associated with higher spending levels and lower risks of spending reductions. Local public health agency spending was inversely associated with local-area medical spending. The mechanisms that determine funding flows to local agencies may place some communities at a disadvantage in securing resources for public health activities.

Anesthesia Care Team Composition and Surgical Outcomes.

PubMed

Sun, Eric C; Miller, Thomas R; Moshfegh, Jasmin; Baker, Laurence C

2018-05-24

In the United States, anesthesia care can be provided by an anesthesia care team consisting of nonphysician providers (nurse anesthetists and anesthesiologist assistants) working under the supervision of a physician anesthesiologist. Nurse anesthetists may practice nationwide, whereas anesthesiologist assistants are restricted to 16 states. To inform policies concerning the expanded use of anesthesiologist assistants, the authors examined whether the specific anesthesia care team composition (physician anesthesiologist plus nurse anesthetist or anesthesiologist assistant) was associated with differences in perioperative outcomes. A retrospective analysis was performed of national claims data for 443,098 publicly insured elderly (ages 65 to 89 yr) patients who underwent inpatient surgery between January 1, 2004, and December 31, 2011. The differences in inpatient mortality, spending, and length of stay between cases where an anesthesiologist supervised an anesthesiologist assistant compared to cases where an anesthesiologist supervised a nurse anesthetist were estimated. The approach used a quasirandomization technique known as instrumental variables to reduce confounding. The adjusted mortality for care teams with anesthesiologist assistants was 1.6% (95% CI, 1.4 to 1.8) versus 1.7% for care teams with nurse anesthetists (95% CI, 1.7 to 1.7; difference -0.08; 95% CI, -0.3 to 0.1; P = 0.47). Compared to care teams with nurse anesthetists, care teams with anesthesiologist assistants were associated with non-statistically significant decreases in length of stay (-0.009 days; 95% CI, -0.1 to 0.1; P = 0.89) and medical spending (-$56; 95% CI, -334 to 223; P = 0.70). The specific composition of the anesthesia care team was not associated with any significant differences in mortality, length of stay, or inpatient spending.

The Impact of State Medical Malpractice Reform on Individual-Level Health Care Expenditures.

PubMed

Yu, Hao; Greenberg, Michael; Haviland, Amelia

2017-12-01

Past studies of the impact of state-level medical malpractice reforms on health spending produced mixed findings. Particularly salient is the evidence gap concerning the effect of different types of malpractice reform. This study aims to fill the gap. It extends the literature by examining the general population, not a subgroup or a specific health condition, and controlling for individual-level sociodemographic and health status. We merged the Database of State Tort Law Reforms with the Medical Expenditure Panel Survey between 1996 and 2012. We took a difference-in-differences approach to specify a two-part model for analyzing individual-level health spending. We applied the recycled prediction method and the bootstrapping technique to examining the difference in health spending growth between states with and without a reform. All expenditures were converted to 2010 U.S. dollars. Only two of the 10 major state-level malpractice reforms had significant impacts on the growth of individual-level health expenditures. The average annual expenditures in states with caps on attorney contingency fees increased less than that in states without the reform (p < .05). Compared with states with traditional contributory negligence rule, the average annual expenditures increased more in both states with a pure comparative fault reform (p < .05) and states with a comparative fault reform that barred recovery if the plaintiff's fault was equal to or greater than the defendant's (p < .05). A few state-level malpractice reforms had significantly affected the growth of individual-level health spending, and the direction and magnitude of the effects differed by type of reform. © Health Research and Educational Trust.

Trends in hospital cost and revenue, 1994-2005: how are they related to HMO penetration, concentration, and for-profit ownership?

PubMed

Shen, Yu-Chu; Wu, Vivian Y; Melnick, Glenn

2010-02-01

Analyze trends in hospital cost and revenue, as well as price and quantity (1994-2005) as a function of health maintenance organization (HMO) penetration, HMO concentration, and for-profit (FP) HMO market share. Medicare hospital cost reports, AHA Annual Surveys, HMO data from Interstudy, and other supplemental data. A retrospective study of all short-term, general, nonfederal hospitals in metropolitan statistical areas (MSAs) in the United States from 1994 to 2005, using hospital/MSA fixed-effects translog regression models. A 10 percentage point increase in HMO enrollment is associated with 4.1-4.2 percent reduction in costs and revenues in the pre-2000 period but only a 2.1-2.5 percent reduction in the post-2000 period. Hospital revenue in HMO-dominant markets (highly concentrated HMO market and competitive hospital market) is 19-27 percent lower than other types of markets, and the difference is most likely due mainly to lower prices and to a lesser extent lower utilization. The historical difference of lower spending in high HMO penetration markets compared with low HMO markets narrowed after 2000 and the relative concentration between HMO and hospital markets can substantially influence hospital spending. Additional research is needed to understand how different aspects of these two markets have changed and interacted and how they are causally linked to spending trends.

A New Application to Facilitate Post-Fire Recovery and Rehabilitation in Savanna Ecosystems

NASA Technical Reports Server (NTRS)

Carroll, Mark L.; Schnase, John L.; Weber, Keith T.; Brown, Molly E.; Gill, Roger L.; Haskett, George W.; Gardner, Tess A.

2013-01-01

The U.S. government spends an estimated $3billion per year to fight forest fires in the United States. Post-fire rehabilitation activities represent a small but essential portion of that total. The Rehabilitation Capability Convergence for Ecosystem Recovery (RECOVER) system is currently under development for Savanna ecosystems in the western U.S. The prototype of this system has been built and will have realworld testing during the summer 2013 fire season. When fully deployed, the RECOVER system will provide the emergency rehabilitation teams with critical and timely information for management decisions regarding stabilization and rehabilitation strategies.

Remarks of Jo Anne B. Barnhart, Assistant Secretary, Administration for Children and Families, U.S. Department of Health and Human Services before the National Association of Child Care Resource and Referral Agencies (Washington, D.C., February 20, 1992).

ERIC Educational Resources Information Center

Barnhart, Jo Anne B.

One of the goals of the America 2000 initiative is that by the year 2000, all children in the United States will start school ready to learn. Child care will play a major role in the achievement of this goal due to the fact that nearly half of all preschool children spend a significant portion of time in child care settings outside of the home.…

The effects of state-level expenditures for home- and community-based services on the risk of becoming a long-stay nursing home resident after hip fracture.

PubMed

Blackburn, J; Locher, J L; Morrisey, M A; Becker, D J; Kilgore, M L

2016-03-01

This study measures the effect of spending policies for long-term care services on the risk of becoming a long-stay nursing home resident after a hip fracture. Relative spending on community-based services may reduce the risk of long-term nursing home residence. Policies favoring alternative sources of care may provide opportunities for older adults to remain community-bound. This study aims to understand how long-term care policies affect outcomes by investigating the effect of state-level spending for home- and community-based services (HCBSs) on the likelihood of an individual's nursing home placement following hip fracture. This study uses data from the 5% sample of Medicare beneficiaries from 2005 to 2010 to identify incident hip fractures among dual-eligibility, community-dwelling adults aged at least 65 years. A multilevel generalized estimating equation (GEE) model estimated the association between an individual's risk of nursing home residence within 1 year and the percent of states' Medicaid long-term support service (LTSS) budget allocated to HCBS. Other covariates included expenditures for Title III services and individual demographic and health status characteristics. States vary considerably in HCBS spending, ranging from 17.7 to 83.8% of the Medicaid LTSS budget in 2009. Hip fractures were observed from claims among 7778 beneficiaries; 34% were admitted to a nursing home and 25% died within 1 year. HCBS spending was associated with a decreased risk of nursing home residence by 0.17 percentage points (p 0.056). Consistent with other studies, our findings suggest that state policies favoring an emphasis on HCBS may reduce nursing home residence among low-income older adults with hip fracture who are at high risk for institutionalization.

Dollars for lives: the effect of highway capital investments on traffic fatalities.

PubMed

Nguyen-Hoang, Phuong; Yeung, Ryan

2014-12-01

This study examines the effect of highway capital investments on highway fatalities. We used state-level data from the 48 contiguous states in the United States from 1968 through 2010 to estimate the effects on highway fatalities of capital expenditures and highway capital stock. We estimated these effects by controlling for a set of control variables together with state and year dummy variables and state-specific linear time trends. We found that capital expenditures and capital stock had significant and negative effects on highway fatalities. States faced with declines in gas tax revenues have already cut back drastically on spending on roads including on maintenance and capital outlay. If this trend continues, it may undermine traffic safety. While states and local governments are currently fiscally strained, it is important for them to continue investments in roadways to enhance traffic safety and, more significantly, to save lives. Copyright © 2014 National Safety Council and Elsevier Ltd. All rights reserved.

Establishing a Baseline: Community Benefit Spending by Not-for-Profit Hospitals Prior to Implementation of the Affordable Care Act

PubMed Central

Tung, Greg J.; Lindrooth, Richard C.; Johnson, Emily K.; Hardy, Rose; Castrucci, Brian C.

2017-01-01

Context: Community Benefit spending by not-for-profit hospitals has served as a critical, formalized part of the nation's safety net for almost 50 years. This has occurred mostly through charity care. This article examines how not-for-profit hospitals spent Community Benefit dollars prior to full implementation of the Affordable Care Act (ACA). Methods: Using data from 2009 to 2012 hospital tax and other governmental filings, we constructed national, hospital-referral-region, and facility-level estimates of Community Benefit spending. Data were collected in 2015 and analyzed in 2015 and 2016. Data were matched at the facility level for a non-profit hospital's IRS tax filings (Form 990, Schedule H) and CMS Hospital Cost Report Information System and Provider of Service data sets. Results: During 2009, hospitals spent about 8% of total operating expenses on Community Benefit. This increased to between 8.3% and 8.5% in 2012. The majority of spending (>80%) went toward charity care, unreimbursed Medicaid, and subsidized health services, with approximately 6% going toward both community health improvement and health professionals' education. By 2012, national spending on Community Benefit likely exceeded $60 billion. The largest hospital systems spent the vast majority of the nation's Community Benefit; the top 25% of systems spent more than 80 cents of every Community Benefit dollar. Discussion: Community Benefit spending has remained relatively steady as a proportion of total operating expenses and so has increased over time—although charity care remains the major focus of Community Benefit spending overall. Implications: More than $60 billion was spent on Community Benefit prior to implementation of the ACA. New reporting and spending requirements from the IRS, alongside changes by the ACA, are changing incentives for hospitals in how they spend Community Benefit dollars. In the short term, and especially the long term, hospital systems would do well to partner with public health, other social services, and even competing hospitals to invest in population-based activities. The mandated community health needs assessment process is a logical home for these sorts of collaborations. Relatively modest investments can improve the baseline level of health in their communities and make it easier to improve population health. Aside from a population health justification for a partnership model, a business case is necessary for widespread adoption of this approach. Because of their authorities, responsibilities, and centuries of expertise in community health, public health agencies are in a position to help hospitals form concrete, sustainable collaborations for the improvement of population health. Conclusion: The ACA will likely change the delivery of uncompensated and charity care in the United States in the years to come. How hospitals choose to spend those dollars may be influenced greatly by the financial and political environments, as well as the strength of community partnerships. PMID:27997478

Establishing a Baseline: Community Benefit Spending by Not-for-Profit Hospitals Prior to Implementation of the Affordable Care Act.

PubMed

Leider, Jonathon P; Tung, Greg J; Lindrooth, Richard C; Johnson, Emily K; Hardy, Rose; Castrucci, Brian C

Community Benefit spending by not-for-profit hospitals has served as a critical, formalized part of the nation's safety net for almost 50 years. This has occurred mostly through charity care. This article examines how not-for-profit hospitals spent Community Benefit dollars prior to full implementation of the Affordable Care Act (ACA). Using data from 2009 to 2012 hospital tax and other governmental filings, we constructed national, hospital-referral-region, and facility-level estimates of Community Benefit spending. Data were collected in 2015 and analyzed in 2015 and 2016. Data were matched at the facility level for a non-profit hospital's IRS tax filings (Form 990, Schedule H) and CMS Hospital Cost Report Information System and Provider of Service data sets. During 2009, hospitals spent about 8% of total operating expenses on Community Benefit. This increased to between 8.3% and 8.5% in 2012. The majority of spending (>80%) went toward charity care, unreimbursed Medicaid, and subsidized health services, with approximately 6% going toward both community health improvement and health professionals' education. By 2012, national spending on Community Benefit likely exceeded $60 billion. The largest hospital systems spent the vast majority of the nation's Community Benefit; the top 25% of systems spent more than 80 cents of every Community Benefit dollar. Community Benefit spending has remained relatively steady as a proportion of total operating expenses and so has increased over time-although charity care remains the major focus of Community Benefit spending overall. More than $60 billion was spent on Community Benefit prior to implementation of the ACA. New reporting and spending requirements from the IRS, alongside changes by the ACA, are changing incentives for hospitals in how they spend Community Benefit dollars. In the short term, and especially the long term, hospital systems would do well to partner with public health, other social services, and even competing hospitals to invest in population-based activities. The mandated community health needs assessment process is a logical home for these sorts of collaborations. Relatively modest investments can improve the baseline level of health in their communities and make it easier to improve population health. Aside from a population health justification for a partnership model, a business case is necessary for widespread adoption of this approach. Because of their authorities, responsibilities, and centuries of expertise in community health, public health agencies are in a position to help hospitals form concrete, sustainable collaborations for the improvement of population health. The ACA will likely change the delivery of uncompensated and charity care in the United States in the years to come. How hospitals choose to spend those dollars may be influenced greatly by the financial and political environments, as well as the strength of community partnerships.

Privatization in a publicly funded health care system: the U.S. experience.

PubMed

Himmelstein, David U; Woolhandler, Steffie

2008-01-01

The United States has four decades of experience with the combination of public funding and private health care management and delivery, closely analogous to reforms recently enacted or proposed in many other nations. Extensive research, herein reviewed, shows that for-profit health institutions provide inferior care at inflated prices. The U.S. experience also demonstrates that market mechanisms nurture unscrupulous medical businesses and undermine medical institutions unable or unwilling to tailor care to profitability. The commercialization of care in the United States has driven up costs by diverting money to profits and by fueling a vast increase in management and financial bureaucracy, which now consumes 31 percent of total health spending. The Veterans Health Administration system--a network of government hospitals and clinics--has emerged as the leader in quality improvement and information technology, indicating the potential for public sector excellence and innovation. The poor performance of U.S. health care is directly attributable to reliance on market mechanisms and for-profit firms, and should warn other nations from this path.

The One-Year Crew returns on This Week @NASA – March 4, 2016

NASA Image and Video Library

2016-03-04

After spending nearly a year aboard the International Space Station -- conducting a host of biomedical and psychological research on the impacts of long-duration spaceflight on the human body, NASA’s Scott Kelly and Mikhail Kornienko of the Russian space agency Roscosmos wrapped up their historic mission on March 1 – with a safe parachute landing in Kazakhstan . Just over a day, later – at Houston’s Ellington Field, near Johnson Space Center, a host of family, colleagues and VIPs welcomed Kelly back to the United States, including Second Lady of the United States Dr. Jill Biden, Assistant to the President for Science and Technology Dr. John P. Holdren, and NASA Administrator Charles Bolden. There were cheers, embraces and expressions of appreciation for his efforts to help advance deep space exploration and America’s Journey to Mars. Also, Next ISS crew heads to launch site, “Low boom” aircraft, Orion Service Module’s solar array wing deployment and more!

Educating and Inspiring Young People for the Next Generation of Exploration

NASA Technical Reports Server (NTRS)

Armstrong, Robert C., Jr.

2007-01-01

With the graying of the nation's scientific workforce and the decline in students pursuing science, technological, engineering, and math related-studies, real challenges lie ahead if America is to continue to sustain the Vision for Space Exploration in the foreseeable future. Likewise, challenges exist in the economic arena as the United States seeks to maintain its preeminence among the technological leaders of the world. Currently, less than 6 percent of high school seniors are pursuing engineering degrees, down from 36 percent a decade ago. Today, China produces six times as many engineers as does the United States and Japan, at half our population, develops twice as many engineers. Despite spending more per capita on public education than any other nation, except Switzerland, U.S. students of high school age are failing to compete with many foreign countries. These trends do not bode well for America's future competitiveness in space and other technically driven areas, such as defense.

Extended family households among children in the United States: Differences by race/ethnicity and socio-economic status.

PubMed

Cross, Christina J

2018-07-01

This study uses nationally representative longitudinal data from the Panel Study of Income Dynamics, to examine the prevalence and predictors of extended family households among children in the United States and to explore variation by race/ethnicity and socio-economic status (SES). Findings suggest that extended family households are a common living arrangement for children, with 35 per cent of youth experiencing this family structure before age 18. Racial/ethnic and SES differences are substantial: 57 per cent of Black and 35 per cent of Hispanic children ever live in an extended family, compared with 20 per cent of White children. Further, 47 per cent of children whose parents did not finish high school spend time in an extended family, relative to 17 per cent of children whose parents earned a bachelor's degree or higher. Models of predictors show that transitions into extended families are largely a response to social and economic needs.

NAVIGATING the Future Through the Past The Enduring Historical Legacy of Federal Children's Health Programs in the United States

PubMed Central

2012-01-01

The United States excels at treating the most complex medical conditions, but our low-ranking health statistics (relative to other countries) do not match our high-end health care spending. One way to understand this paradox is to examine the history of federal children's health programs. In the 1800s, children's health advocates confronted social determinants of health to reduce infant mortality. Over the past 100 years, however, physicians have increasingly focused on individual doctor–patient encounters; public health professionals, meanwhile, have maintained a population health perspective but struggled with the politics of addressing root causes of disease. Political history and historical demography help explain some salient differences with European nations that date to the founding of federal children's health programs in the early 20th century. More recently, federal programs for children with intellectual disability illustrate technical advances in medicine, shifting children's health epidemiology, and the politics of public health policy. PMID:22897550

NAVIGATING the future through the past: the enduring historical legacy of federal children's health programs in the United States.

PubMed

Brosco, Jeffrey Paul

2012-10-01

The United States excels at treating the most complex medical conditions, but our low-ranking health statistics (relative to other countries) do not match our high-end health care spending. One way to understand this paradox is to examine the history of federal children's health programs. In the 1800s, children's health advocates confronted social determinants of health to reduce infant mortality. Over the past 100 years, however, physicians have increasingly focused on individual doctor-patient encounters; public health professionals, meanwhile, have maintained a population health perspective but struggled with the politics of addressing root causes of disease. Political history and historical demography help explain some salient differences with European nations that date to the founding of federal children's health programs in the early 20th century. More recently, federal programs for children with intellectual disability illustrate technical advances in medicine, shifting children's health epidemiology, and the politics of public health policy.

After the oil boom: The holiday ends in the gulf

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

Zanoyan, V.

1995-11-01

The most unmanageable risk facing American interests in the Persian Gulf is the slow but sure decay of the economic and political structure of the United States` key regional allies. They are the Gulf Cooperation Council (GCC) states: Saudia Arabia, Kuwait, Bahrain, Qatar, Oman, and the United Arab Emirates (UAE). External threats to these friendly governments and the direct risks to the continued flow of oil has blinded Washington to the end of these countries 20-year holiday from politics and economics. The holiday from economics was characterized by, among other syndromes, the lack of binding budget constraints, which reduced andmore » sometimes even eliminated the need to set spending priorities and allocate scarce economic resources. It is no longer possible to cover up structural weaknesses and policy inconsistencies. All major interest groups, including governments, ruling families, merchant families, and the population at large, are under pressure to earn not only their privileges but their keep. The need for Washington to address these new threats is examined.« less

Children's Budget Watch: Investments in Our Future. A Profile of State and Federal Spending for Children in Pennsylvania, FY 1989-1990 through FY 1995-1996.

ERIC Educational Resources Information Center

Pennsylvania Partnerships for Children, Harrisburg.

This report profiles trends in state and federal spending for children in Pennsylvania from fiscal year (FY) 1989-1990 through 1995-1996, and highlights budgetary trends and the impact of federal welfare reform on selected children's health, nutrition, early care and education, elementary and secondary education, income support, and child welfare…

Changes in Health Care Spending and Quality 4 Years into Global Payment

PubMed Central

Song, Zirui; Rose, Sherri; Safran, Dana G.; Landon, Bruce E.; Day, Matthew P.; Chernew, Michael E.

2014-01-01

BACKGROUND Spending and quality under global budgets remain unknown beyond 2 years. We evaluated spending and quality measures during the first 4 years of the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract (AQC). METHODS We compared spending and quality among enrollees whose physician organizations entered the AQC from 2009 through 2012 with those among persons in control states. We studied spending changes according to year, category of service, site of care, experience managing risk contracts, and price versus utilization. We evaluated process and outcome quality. RESULTS In the 2009 AQC cohort, medical spending on claims grew an average of $62.21 per enrollee per quarter less than it did in the control cohort over the 4-year period (P<0.001). This amount is equivalent to a 6.8% savings when calculated as a proportion of the average post-AQC spending level in the 2009 AQC cohort. Analogously, the 2010, 2011, and 2012 cohorts had average savings of 8.8% (P<0.001), 9.1% (P<0.001), and 5.8% (P = 0.04), respectively, by the end of 2012. Claims savings were concentrated in the outpatient-facility setting and in procedures, imaging, and tests, explained by both reduced prices and reduced utilization. Claims savings were exceeded by incentive payments to providers during the period from 2009 through 2011 but exceeded incentive payments in 2012, generating net savings. Improvements in quality among AQC cohorts generally exceeded those seen elsewhere in New England and nationally. CONCLUSIONS As compared with similar populations in other states, Massachusetts AQC enrollees had lower spending growth and generally greater quality improvements after 4 years. Although other factors in Massachusetts may have contributed, particularly in the later part of the study period, global budget contracts with quality incentives may encourage changes in practice patterns that help reduce spending and improve quality. (Funded by the Commonwealth Fund and others.) PMID:25354104

Government and charity funding of cancer research: public preferences and choices.

PubMed

Shah, Koonal Kirit; Sussex, Jon; Hernandez-Villafuerte, Karla

2015-09-03

It is unclear how the public would respond to changes in government decisions about how much to spend on medical research in total and specifically on major disease areas such as cancer. Our aim was to elicit the views of the general public in the United Kingdom about how a change in government spending on cancer research might affect their willingness to donate, or to hypothecate a portion of their income tax payments, to cancer research charities. A web-based stated preference survey was conducted in 2013. Respondents considered hypothetical scenarios regarding changes in the levels of government funding for medical research. In each scenario, respondents were asked to imagine that they could allocate £100 of the income tax they paid this year to one or more medical research charities. They were asked how they wished to allocate the £100 between cancer research charities and medical research charities concerned with diseases other than cancer. After having been given the opportunity to allocate £100 in this way, respondents were then asked if they would want to reduce or increase any personal out-of-pocket donations that they already make to cancer research and non-cancer medical research charities. Descriptive analyses and random effects modelling were used to examine patterns in the response data. The general tendency of respondents was to act to offset hypothetical changes in government spending. When asked to imagine that the government had reduced (or increased) its spending on cancer research, the general tendency of respondents was to state that they would give a larger (or smaller) allocation of their income tax to cancer research charities, and to increase (or reduce) their personal out-of-pocket donations to cancer research charities. However, most respondents' preferred allocation splits and changes in personal donations did not vary much from scenario to scenario. Many of the differences between scenarios were small and non-significant. The public's decisions about how much to donate to cancer research or other medical research charities are not greatly affected by (hypothetical) changes to government plans about the amount of public funding of cancer or other medical research.

The US healthcare workforce and the labor market effect on healthcare spending and health outcomes.

PubMed

Pellegrini, Lawrence C; Rodriguez-Monguio, Rosa; Qian, Jing

2014-06-01

The healthcare sector was one of the few sectors of the US economy that created new positions in spite of the recent economic downturn. Economic contractions are associated with worsening morbidity and mortality, declining private health insurance coverage, and budgetary pressure on public health programs. This study examines the causes of healthcare employment growth and workforce composition in the US and evaluates the labor market's impact on healthcare spending and health outcomes. Data are collected for 50 states and the District of Columbia from 1999-2009. Labor market and healthcare workforce data are obtained from the Bureau of Labor Statistics. Mortality and health status data are collected from the Centers for Disease Control and Prevention's Vital Statistics program and Behavioral Risk Factor Surveillance System. Healthcare spending data are derived from the Centers for Medicare and Medicaid Services. Dynamic panel data regression models, with instrumental variables, are used to examine the effect of the labor market on healthcare spending, morbidity, and mortality. Regression analysis is also performed to model the effects of healthcare spending on the healthcare workforce composition. All statistical tests are based on a two-sided [Formula: see text] significance of [Formula: see text] .05. Analyses are performed with STATA and SAS. The labor force participation rate shows a more robust effect on healthcare spending, morbidity, and mortality than the unemployment rate. Study results also show that declining labor force participation negatively impacts overall health status ([Formula: see text] .01), and mortality for males ([Formula: see text] .05) and females ([Formula: see text] .001), aged 16-64. Further, the Medicaid and Medicare spending share increases as labor force participation declines ([Formula: see text] .001); whereas, the private healthcare spending share decreases ([Formula: see text] .001). Public and private healthcare spending also has a differing effect on healthcare occupational employment per 100,000 people. Private healthcare spending positively impacts primary care physician employment ([Formula: see text] .001); whereas, Medicare spending drives up employment of physician assistants, registered nurses, and personal care attendants ([Formula: see text] .001). Medicaid and Medicare spending has a negative effect on surgeon employment ([Formula: see text] .05); the effect of private healthcare spending is positive but not statistically significant. Labor force participation, as opposed to unemployment, is a better proxy for measuring the effect of the economic environment on healthcare spending and health outcomes. Further, during economic contractions, Medicaid and Medicare's share of overall healthcare spending increases with meaningful effects on the configuration of state healthcare workforces and subsequently, provision of care for populations at-risk for worsening morbidity and mortality.

[Municipal public health spending in the state of Pernambuco, Brazil, from 2000 to 2007].

PubMed

Espírito Santo, Antônio Carlos Gomes do; Fernando, Virgínia Conceição Nascimento; Bezerra, Adriana Falangola Benjamin

2012-04-01

In order to assess the impact of macro-political measures implemented in the latter half of the 1990s on the increase in public spending on health and the possible reduction in allocation inequity, a descriptive, quantitative, cross-sectional study was carried out involving 184 municipalities in the state of Pernambuco, Brazil. Data from the Public Health Budget Information System was used, with the selected indicator being spending on health per inhabitant under the responsibility of the municipality. The correlations of this variable with the municipal Human Development Index, population size and value of the municipal budget per capita were analyzed. It was seen that, although the mean increase in municipal spending on health is 190.76%, the value per capita has remained relatively low - at around R$183.79 - which is below the national and macro-regional averages. Both spending on health per capita and growth percentages are distributed irregularly among health regions as well as among municipalities within a single region. In conclusion, there is marked allocation inequity among municipalities with regard to the distribution of public resources for health, despite the macro-political measures adopted to reduce this inequity.

Educational inequalities in health in European welfare states: a social expenditure approach.

PubMed

Dahl, Espen; van der Wel, Kjetil A

2013-03-01

A puzzle in comparative health inequality research is the finding that egalitarian welfare states do not necessarily demonstrate narrow health inequalities. This paper interrogates into this puzzle by moving beyond welfare regimes to examine how welfare spending affect inequalities in self-rated across Europe. We operationalise welfare spending in four different ways and compare both absolute and relative health inequalities, as well as the level of poor self-rated health in the low education group across varying levels of social spending. The paper employs data from the EU Statistics of Income and Living Conditions (EU-SILC) and includes a sample of approximately 245,000 individuals aged 25-80+ years from 18 European countries. The data were examined by means of gender stratified multilevel logistic regression analyses. The results show that social expenditures are associated with lower health inequalities among women and, to a lesser degree, among men. Especially those with primary education benefit from high social transfers as compared with those who have tertiary education. This means that lower educational inequalities in health - in absolute and relative terms- are linked to higher social spending. The four different operationalisations of social spending produce similar patterns. Copyright © 2012 Elsevier Ltd. All rights reserved.

Accountable Care Organizations in the United States: market and demographic factors associated with formation.

PubMed

Lewis, Valerie A; Colla, Carrie H; Carluzzo, Kathleen L; Kler, Sarah E; Fisher, Elliott S

2013-12-01

The Accountable Care Organization (ACO) model is rapidly being implemented by Medicare, private payers, and states, but little is known about the scope of ACO implementation. To determine the number of accountable care organizations in the United States, where they are located, and characteristics associated with ACO formation. Cross-sectional study of all ACOs in the United States as of August 2012. We identified ACOs from multiple sources; documented service locations (practices, clinics, hospitals); and linked service locations to local areas, defined as Dartmouth Atlas hospital service areas. We used multivariate analysis to assess what characteristics were associated with local ACO presence. We examined demographic characteristics (2010 American Community Survey) and health care system characteristics (2010 Medicare fee-for-service claims data). We identified 227 ACOs located in 27 percent of local areas. Fifty-five percent of the US population resides in these areas. HSA-level characteristics associated with ACO presence include higher performance on quality, higher Medicare per capita spending, fewer primary care physician groups, greater managed care penetration, lower poverty rates, and urban location. Much of the US population resides in areas where ACOs have been established. ACO formation has taken place where it may be easier to meet quality and cost targets. Wider adoption of the ACO model may require tailoring to local context. © Health Research and Educational Trust.

Compulsive buying and depressive symptoms among female citizens of the United Arab Emirates.

PubMed

Thomas, Justin; Al-Menhali, Salwa; Humeidan, Majeda

2016-03-30

Compulsive buying is particularly relevant in nations with high levels of consumer spending. Most previous studies have focused on European and North America populations. This study explores compulsive buying amongst citizens of the United Arab Emirates, an Arab nation with high retail outlet density, and high levels of consumer spending. Female college students (N=100) completed an English/Arabic version of the compulsive buying scale along with a measure of depression. Rates of compulsive buying were higher than those reported in any previously published study. Furthermore, in line with previous findings from other nations, compulsive buying was associated with elevated depressive symptomatology. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Economic Impact of Pacific Northwest National Laboratory on the State of Washington in Fiscal Year 2014

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

Scott, Michael J.; Niemeyer, Jackie M.

PNNL is a large economic entity with a total of 4,308 employees, $939 million (M) in total funding, and $1.02 billion (B) in total spending during FY 2014. The number of employees that live in Washington State is 4,026 or 93 percent of the Laboratory staff. he Laboratory directly and indirectly supported $1.45 billion in economic output, 6,832 jobs, and $517 million in Washington State wage income from current operations. The state also gained more than $1.19 billion in output, over 6,200 jobs, and $444 million in income through closely related economic activities such as visitors, health care spending, spendingmore » by resident retirees, and spinoff companies. PNNL affects Washington’s economy through commonly recognized economic channels, including spending on payrolls and other goods and services that support Laboratory operations. Less commonly recognized channels also have their own impacts and include company-supported spending on health care for its staff members and retirees, spending of its resident retirees, Laboratory visitor spending, and the economic activities in a growing constellation of “spinoff” companies founded on PNNL research, technology, and managerial expertise. PNNL also has a significant impact on science and technology education and community not-for-profit organizations. PNNL is an active participant in the future scientific enterprise in Washington with the state’s K-12 schools, colleges, and universities. The Laboratory sends staff members to the classroom and brings hundreds of students to the PNNL campus to help train the next generation of scientists, engineers, mathematicians, and technicians. This investment in human capital, though difficult to measure in terms of current dollars of economic output, is among the important lasting legacies of the Laboratory. Finally, PNNL contributes to the local community with millions of dollars’ worth of cash and in-kind corporate and staff contributions, all of which strengthen the economy. The purpose of this report is to quantify these effects, providing detailed information on PNNL’s revenues and expenditures, as well as the impacts of its activities on the rest of the Washington State economy.« less

The United States of America and scientific research.

PubMed

Hather, Gregory J; Haynes, Winston; Higdon, Roger; Kolker, Natali; Stewart, Elizabeth A; Arzberger, Peter; Chain, Patrick; Field, Dawn; Franza, B Robert; Lin, Biaoyang; Meyer, Folker; Ozdemir, Vural; Smith, Charles V; van Belle, Gerald; Wooley, John; Kolker, Eugene

2010-08-16

To gauge the current commitment to scientific research in the United States of America (US), we compared federal research funding (FRF) with the US gross domestic product (GDP) and industry research spending during the past six decades. In order to address the recent globalization of scientific research, we also focused on four key indicators of research activities: research and development (R&D) funding, total science and engineering doctoral degrees, patents, and scientific publications. We compared these indicators across three major population and economic regions: the US, the European Union (EU) and the People's Republic of China (China) over the past decade. We discovered a number of interesting trends with direct relevance for science policy. The level of US FRF has varied between 0.2% and 0.6% of the GDP during the last six decades. Since the 1960s, the US FRF contribution has fallen from twice that of industrial research funding to roughly equal. Also, in the last two decades, the portion of the US government R&D spending devoted to research has increased. Although well below the US and the EU in overall funding, the current growth rate for R&D funding in China greatly exceeds that of both. Finally, the EU currently produces more science and engineering doctoral graduates and scientific publications than the US in absolute terms, but not per capita. This study's aim is to facilitate a serious discussion of key questions by the research community and federal policy makers. In particular, our results raise two questions with respect to: a) the increasing globalization of science: "What role is the US playing now, and what role will it play in the future of international science?"; and b) the ability to produce beneficial innovations for society: "How will the US continue to foster its strengths?"

A portrait of pediatric radiologists in the United States.

PubMed

Merewitz, Leonard; Sunshine, Jonathan H

2006-01-01

In recognition of the importance of pediatric radiology and the apparent shortage of radiologists in the field, the purpose of this study was to provide an extensive and detailed portrait of pediatric radiologists, their professional activities, and the practices in which they work. We tabulated data from the American College of Radiology's 2003 Survey of Radiologists, a stratified random sample survey that achieved a 63% response rate with a total of 1,924 responses. Responses were weighted to make them representative of all radiologists in the United States. We compare information about pediatric radiologists with that for other radiologists. Approximately 3% of radiologists, some 800-900 physicians, are pediatric radiologists. Depending on how pediatric radiologist is defined, two thirds to three quarters of them spend 70% or more of their clinical work time doing pediatric radiology. Unlike other radiologists, a greater percentage of pediatric radiologists desire a reduction in workload (with a corresponding reduction in income) than desire an increase in workload. Pediatric radiologists who spend 70% or more of their clinical work time in their field are older than radiologists in general (average age, 55 vs 51 years), and the fraction of pediatric radiologists younger than 45 years is lower than for other subspecialists ( approximately 20% vs 37%). Pediatric radiologists are disproportionately women (one third or more, depending on definition, are women, vs 19% for other subspecialists and 15% for nonsubspecialists), hospital-based, in academic practices (approximately half vs one fifth for other subspecialists), and in the main cities of large metropolitan areas. A shortage of pediatric radiologists exists and is likely to intensify. Access to pediatric radiologists is probably a problem except for children in large metropolitan areas who connect readily to academic hospitals. Means to overcome these problems need to be actively sought.

Estimating the Medical Care Costs of Obesity in the United States: Systematic Review, Meta-Analysis, and Empirical Analysis.

PubMed

Kim, David D; Basu, Anirban

2016-01-01

The prevalence of adult obesity exceeds 30% in the United States, posing a significant public health concern as well as a substantial financial burden. Although the impact of obesity on medical spending is undeniably significant, the estimated magnitude of the cost of obesity has varied considerably, perhaps driven by different study methodologies. To document variations in study design and methodology in existing literature and to understand the impact of those variations on the estimated costs of obesity. We conducted a systematic review of the twelve recently published articles that reported costs of obesity and performed a meta-analysis to generate a pooled estimate across those studies. Also, we performed an original analysis to understand the impact of different age groups, statistical models, and confounder adjustment on the magnitude of estimated costs using the nationally representative Medical Expenditure Panel Surveys from 2008-2010. We found significant variations among cost estimates in the existing literature. The meta-analysis found that the annual medical spending attributable to an obese individual was $1901 ($1239-$2582) in 2014 USD, accounting for $149.4 billion at the national level. The two most significant drivers of variability in the cost estimates were age groups and adjustment for obesity-related comorbid conditions. It would be important to acknowledge variations in the magnitude of the medical cost of obesity driven by different study design and methodology. Researchers and policy-makers need to be cautious on determining appropriate cost estimates according to their scientific and political questions. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

A Survey of the Current Utilization of Asynchronous Education Among Emergency Medicine Residents in the United States

PubMed Central

Schlein, Sarah; Doctor, Shaneen; Stroud, Susan; Dawson, Matthew; Fix, Megan

2014-01-01

Problem Medical education is transitioning from traditional learning methods. Resident interest in easily accessible education materials is forcing educators to reevaluate teaching methodology. Approach To determine emergency medicine residents’ current methods of and preferences for obtaining medical knowledge, the authors created a survey and sent it to residents, at all levels of training throughout the United States, whose e-mail addresses were available via their residency’s official Web site (June–December 2012). The eight-question voluntary survey asked respondents about demographics, their use of extracurricular time, and the materials they perceived as most beneficial. The authors used descriptive statistics to analyze results. Outcomes Of the 401 residents who received the e-mailed survey, 226 (56.3%) completed it. Of these, 97.7% reported spending at least one hour per week engaging in extracurricular education, and 34.5% reported spending two to four hours per week (P < .001). Time listening to podcasts was the most popular (reported by 35.0% of residents), followed by reading textbooks (33.6%) and searching Google (21.4%; P < .001). Residents endorsed podcasts as the most beneficial (endorsed by 70.3%) compared with textbooks (endorsed by 54.3%), journals (36.5%), and Google (33.8%; P < .001). Most respondents reported evaluating the quality of evidence or reviewing references “rarely” or less than half the time. A majority (80.0%) selected the topics they accessed based on recent clinical encounters. Next Steps The results suggest that residents are using more open access interactive multimedia tools. Medical educators must engage with current learners to guide appropriate use of these. PMID:24556776

Recent trends in the probability of high out-of-pocket medical expenses in the United States

PubMed Central

Baird, Katherine E

2016-01-01

Objective: This article measures the probability that out-of-pocket expenses in the United States exceed a threshold share of income. It calculates this probability separately by individuals’ health condition, income, and elderly status and estimates changes occurring in these probabilities between 2010 and 2013. Data and Method: This article uses nationally representative household survey data on 344,000 individuals. Logistic regressions estimate the probabilities that out-of-pocket expenses exceed 5% and alternatively 10% of income in the two study years. These probabilities are calculated for individuals based on their income, health status, and elderly status. Results: Despite favorable changes in both health policy and the economy, large numbers of Americans continue to be exposed to high out-of-pocket expenditures. For instance, the results indicate that in 2013 over a quarter of nonelderly low-income citizens in poor health spent 10% or more of their income on out-of-pocket expenses, and over 40% of this group spent more than 5%. Moreover, for Americans as a whole, the probability of spending in excess of 5% of income on out-of-pocket costs increased by 1.4 percentage points between 2010 and 2013, with the largest increases occurring among low-income Americans; the probability of Americans spending more than 10% of income grew from 9.3% to 9.6%, with the largest increases also occurring among the poor. Conclusion: The magnitude of out-of-pocket’s financial burden and the most recent upward trends in it underscore a need to develop good measures of the degree to which health care policy exposes individuals to financial risk, and to closely monitor the Affordable Care Act’s success in reducing Americans’ exposure to large medical bills. PMID:27651901

Healthcare Utilization and Spending for Constipation in Children With Versus Without Complex Chronic Conditions.

PubMed

Stephens, John R; Steiner, Michael J; DeJong, Neal; Rodean, Jonathan; Hall, Matt; Richardson, Troy; Berry, Jay G

2017-01-01

The aim of the study was to examine the prevalence of diagnosis and treatment for constipation among children receiving Medicaid and to compare healthcare utilization and spending for constipation among children based on number of complex chronic conditions (CCCs). Retrospective cohort study of 4.9 million children ages 1 to 17 years enrolled in Medicaid from 2009 to 2011 in 10 states in the Truven Marketscan Database. Constipation was identified using International Classification of Disease, 9th revision codes for constipation (564.0x), intestinal impaction (560.3x), or encopresis (307.7). Outpatient and inpatient utilization and spending for constipation were assessed. CCC status was identified using validated methodology. A total of 267,188 children (5.4%) were diagnosed with constipation. Total constipation spending was $79.5 million. Outpatient constipation spending was $66.8 million (84.1%) during 406,814 visits, mean spending $120/visit. Among children with constipation, 1363 (0.5%) received inpatient treatment, accounting for $12.2 million (15.4%) of constipation spending, mean spending $7815/hospitalization. Of children hospitalized for constipation, 552 (40.5%) did not have an outpatient visit for constipation before admission. Approximately 6.8% of children in the study had ≥1 CCC; these children accounted for 33.5% of total constipation spending, 70.3% of inpatient constipation spending, and 19.8% of emergency department constipation spending. Constipation prevalence was 11.0% for children with 1 CCC, 16.6% with 2 CCCs, and 27.1% with ≥3 CCCs. Although the majority of pediatric constipation treatment occurs in the outpatient setting, inpatient care accounts for a sizable percentage of spending. Children with CCCs have a higher prevalence of constipation and account for a disproportionate amount of constipation healthcare utilization and spending.

Living on the edge: health care expenses strain family budgets.

PubMed

Cummingham, Peter J; Miller, Carolyn; Cassil, Alwyn

2008-12-01

Affordability of medical care is a central focus of health care reform efforts. As health care costs continue to increase and the economy declines sharply, there is very little cushion in family budgets for health care costs, even for families with insurance coverage. Financial pressures on families from medical bills increase sharply when out-of-pocket spending for health care services exceeds 2.5 percent of family income, according to a new national study by the Center for Studying Health System Change (HSC). Low-income families and people in poor health experience financial pressures at even lower levels of spending, largely because they have already accumulated large medical debts they are unable to pay off. Many Californians also incur substantial burdens from health care expenses, although the rate of medical bill problems is somewhat lower in California compared with the overall United States. Extended interviews with a select number of families facing problems with medical bills provide additional detail on how families are forced to make difficult trade-offs with other family necessities, put off paying other bills, cut down on other expenses and delay getting needed medical care

Challenges facing the United States of America in implementing universal coverage.

PubMed

Rice, Thomas; Unruh, Lynn Y; Rosenau, Pauline; Barnes, Andrew J; Saltman, Richard B; van Ginneken, Ewout

2014-12-01

In 2010, immediately before the United States of America (USA) implemented key features of the Affordable Care Act (ACA), 18% of its residents younger than 65 years lacked health insurance. In the USA, gaps in health coverage and unhealthy lifestyles contribute to outcomes that often compare unfavourably with those observed in other high-income countries. By March 2014, the ACA had substantially changed health coverage in the USA but most of its main features--health insurance exchanges, Medicaid expansion, development of accountable care organizations and further oversight of insurance companies--remain works in progress. The ACA did not introduce the stringent spending controls found in many European health systems. It also explicitly prohibits the creation of institutes--for the assessment of the cost-effectiveness of pharmaceuticals, health services and technologies--comparable to the National Institute for Health and Care Excellence in the United Kingdom of Great Britain and Northern Ireland, the Haute Autorité de Santé in France or the Pharmaceutical Benefits Advisory Committee in Australia. The ACA was--and remains--weakened by a lack of cross-party political consensus. The ACA's performance and its resulting acceptability to the general public will be critical to the Act's future.

Constipation-Related Health Care Utilization in Children Before and After Hospitalization for Constipation.

PubMed

Stephens, John R; Steiner, Michael J; DeJong, Neal; Rodean, Jonathan; Hall, Matt; Richardson, Troy; Berry, Jay G

2018-01-01

We studied constipation-related health care among children before and after constipation admission. Index admissions for constipation in 2010-2011 were identified in the Truven Marketscan Database, which includes children receiving Medicaid in 10 states. We measured number of and spending for outpatient constipation visits 12 months before and after index hospitalizations. We also measured spending for constipation hospitalizations and rehospitalization rate. There were 780 index constipation admissions. The median number of outpatient constipation visits was 1 (interquartile range [IQR] = 0, 3) in the 12 months before and 2 (IQR [0, 4]) after admission ( P = .001). Median outpatient spending for constipation was $110 (IQR [0, 429]) before and $132 (IQR [0, 431]) after admission ( P = .2). Median spending for index constipation admissions was $5295 (IQR [2756, 8267]); 78 children (10%) were rehospitalized for constipation within 12 months. Constipation-related health care utilization increased after constipation admission. Median spending for one constipation admission was 50 times the median spending for 12 months of outpatient constipation visits.

Financing health care in the United Arab Emirates.

PubMed

Taha, Nabila Fahed; Sharif, Amer Ahmad; Blair, Iain

2013-01-01

Newcomers to the United Arab Emirates (UAE) health care system often enquire about the way in which UAE health services are financed particularly when funding issues affect eligibility for treatment. The UAE ranks alongside many western counties on measures of life expectancy and child mortality but because of the unique population structure spends less of its national income on health. In the past as a wealthy country the UAE had no difficulty ensuring universal access to a comprehensive range of services but the health needs of the UAE population are becoming more complex and like many countries the UAE health system is facing the twin challenges of quality and cost. To meet these challenges new models of health care financing are being introduced. In this brief article we will describe the evolution of UAE health financing, its current state and likely future developments.

The Economic Impact of Medicaid Expansion on Pennsylvania.

PubMed

Price, Carter C; Donohue, Julie M; Saltzman, Evan; Woods, Dulani; Eibner, Christine

2013-01-01

The Affordable Care Act is a substantial reform of the U.S. health care insurance system. Using the RAND COMPARE model, researchers assessed the act's potential economic effects on Pennsylvania, factoring in an optional expansion of Medicaid, and found the state would enjoy significant net benefits. With or without the expansion of Medicaid, the act will increase insurance coverage to hundreds of thousands of Pennsylvanians, but the COMPARE model estimates that the expansion of Medicaid eligibility would cover an additional 350,000 people and bring more than $2 billion in federal spending into the state annually than if the state did not expand. Should the state expand Medicaid, the additional spending will add more than $3 billion a year to the state's GDP and support 35,000 jobs. But Medicaid expansion is not without cost for the state; the estimated cumulative effect on Pennsylvania's Medicaid spending will be $180 million higher with the expansion than without between 2014 and 2020. Substantial reductions in uncompensated care costs for hospitals are possible even without expansion, but savings to hospitals for uncompensated care funding are even larger with the Medicaid expansion, amounting to $550 million or more each year.

Comparison of Health Care Spending and Utilization Among Children With Medicaid Insurance

PubMed Central

Kuo, Dennis Z.; Hall, Matt; Agrawal, Rishi; Cohen, Eyal; Feudtner, Chris; Goodman, Denise M.; Neff, John M.; Berry, Jay G.

2015-01-01

BACKGROUND AND OBJECTIVES: Opportunities to improve health care quality and contain spending may differ between high and low resource users. This study’s objectives were to assess health care and spending among children with Medicaid insurance by their resource use. METHODS: Retrospective cross-sectional analysis of 2012 Medicaid health administrative data from 10 states of children ages 11 months to 18 years. Subjects were categorized into 4 spending groups, each representing ∼25% of total spending: the least expensive 80% of children (n = 2 868 267), the next 15% expensive (n = 537 800), the next 4% expensive (n = 143 413), and the top 1% (n = 35 853). We compared per-member-per-month (PMPM) spending across the groups using the Kruskal–Wallis test. RESULTS: PMPM spending was $68 (least expensive 80%), $349 (next 15%), $1200 (next 4%), and $6738 (top 1%). Between the least and most expensive groups, percentages of total spending were higher for inpatient (<1% vs 46%) and mental health (7% vs 24%) but lower for emergency (15% vs 1%) and primary (23% vs 1%) care (all Ps < .001). From the least to most expensive groups, increases in PMPM spending were smallest for primary care (from $15 to $33) and much larger for inpatient ($0.28 to $3129), mental health ($4 to $1609), specialty care ($8 to $768), and pharmacy ($4 to $699). CONCLUSIONS: As resource use increases in children with Medicaid, spending rises unevenly across health services: Spending on primary care rises modestly compared with other health services. Future studies should assess whether more spending on primary care leads to better quality and cost containment for high resource users. PMID:26574588

Perceived Need Versus Current Spending: Gaps in Providing Foundational Public Health Services in Communities.

PubMed

Bekemeier, Betty; Marlowe, Justin; Squires, Linda Sharee; Tebaldi, Jennifer; Park, Seungeun

Our objective was to estimate the gap between the costs for local health jurisdictions (LHJs) to provide foundational public health services (FPHS) and actual spending on FPHS and to examine factors associated with that gap. We employed resource-based cost estimation methods for this observational study and conducted multivariate analyses with measures derived from secondary administrative data. We used primary data collected from LHJ leaders that depicted 2014 spending and perceived need. We also included secondary administrative data depicting annual 2000-2013 expenditures organized into categories containing key elements of FPHS areas. We included primary data from a representative sample of 10 LHJs in Washington State and secondary data for all 35 LHJs in Washington. Participants were public health practice leaders from each sample LHJ. Our main outcome of interest was the gap identified between current spending and the perceived spending needed to provide FPHS in a jurisdiction. Actual FPHS spending was approximately 65% of spending needed to provide overall FPHS for our sample LHJs, but the size of the gap varied substantially by program. Some gaps also varied widely by LHJ, with spending gaps widest among rural and high poverty communities. Percent poverty and the metropolitan nature of a jurisdiction were factors significantly related to FPHS spending in our multivariate analyses. Actual spending lags far behind local officials' estimates of spending needed to provide FPHS and is likely influenced by local conditions. Major apparent gaps between spending and need, particularly in areas such as costly Business Competencies, underscore the need for cross-cutting capabilities to support public health system responsiveness and for attention to be paid to local conditions.

Sylvatic typhus associated with flying squirrels (Glaucomys volans) in New York State, United States.

PubMed

Prusinski, Melissa A; White, Jennifer L; Wong, Susan J; Conlon, Maureen A; Egan, Christina; Kelly-Cirino, Cassandra D; Laniewicz, Brian R; Backenson, P Bryon; Nicholson, William L; Eremeeva, Marina E; Karpathy, Sandor E; Dasch, Gregory A; White, Dennis J

2014-04-01

Sylvatic typhus is an infrequent, potentially life-threatening emerging zoonotic disease. In January of 2009, the New York State Department of Health was notified of a familial cluster of two suspected cases. Due to the paucity of typhus cases in New York, epidemiologic and environmental investigations were conducted to establish rickettsial etiology and determine potential sources of infection. Patients presented with symptoms consistent with typhus, and serologic testing of each patient confirmed infection with typhus group rickettsiae. Serologic analysis of blood obtained from southern flying squirrels (Glaucomys volans) captured from the attic crawlspace above an enclosed front porch of the cases' residence indicated evidence of infection with Rickettsia prowazekii, with 100% seroprevalence (n=11). Both patients reported spending significant time on the porch and hearing animal activity above the ceiling prior to onset of illness, implicating these flying squirrels as the likely source of infection.

Are Alcohol Taxation and Pricing Policies Regressive? Product-Level Effects of a Specific Tax and a Minimum Unit Price for Alcohol.

PubMed

Vandenberg, Brian; Sharma, Anurag

2016-07-01

To compare estimated effects of two policy alternatives, (i) a minimum unit price (MUP) for alcohol and (ii) specific (per-unit) taxation, upon current product prices, per capita spending (A$), and per capita consumption by income quintile, consumption quintile and product type. Estimation of baseline spending and consumption, and modelling policy-to-price and price-to-consumption effects of policy changes using scanner data from a panel of demographically representative Australian households that includes product-level details of their off-trade alcohol spending (n = 885; total observations = 12,505). Robustness checks include alternative price elasticities, tax rates, minimum price thresholds and tax pass-through rates. Current alcohol taxes and alternative taxation and pricing policies are not highly regressive. Any regressive effects are small and concentrated among heavy consumers. The lowest-income consumers currently spend a larger proportion of income (2.3%) on alcohol taxes than the highest-income consumers (0.3%), but the mean amount is small in magnitude [A$5.50 per week (95%CI: 5.18-5.88)]. Both a MUP and specific taxation will have some regressive effects, but the effects are limited, as they are greatest for the heaviest consumers, irrespective of income. Among the policy alternatives, a MUP is more effective in reducing consumption than specific taxation, especially for consumers in the lowest-income quintile: an estimated mean per capita reduction of 11.9 standard drinks per week (95%CI: 11.3-12.6). Policies that increase the cost of the cheapest alcohol can be effective in reducing alcohol consumption, without having highly regressive effects. © The Author 2015. Medical Council on Alcohol and Oxford University Press. All rights reserved.

Does spending on refugees make a difference? A cross-sectional study of the association between refugee program spending and health outcomes in 70 sites in 17 countries.

PubMed

Tan, Timothy M; Spiegel, Paul; Haskew, Christopher; Greenough, P Gregg

2016-01-01

Numerous simultaneous complex humanitarian emergencies strain the ability of local governments and the international community to respond, underscoring the importance of cost-effective use of limited resources. At the end of 2011, 42.5 million people were forcibly displaced, including 10.4 million refugees under the mandate of the United Nations High Commissioner for Refugees (UNHCR). UNHCR spent US$1.65 billion on refugee programs in 2011. We analyze the impact of aggregate-level UNHCR spending on mortality of refugee populations. Using 2011 budget data, we calculated purchasing power parity adjusted spending, disaggregated by population planning groups (PPGs) and UNHCR Results Framework objectives. Monthly mortality reported to UNHCR's Health Information System from 2011 to 2012 was used to calculate crude (CMR) and under-5 (U5MR) mortality rates, and expressed as ratios to country of asylum mortality. Log-linear regressions were performed to assess correlation between spending and mortality. Mortality data for 70 refugee sites representing 1.6 million refugees in 17 countries were matched to 20 PPGs. Median 2011 spending was $623.27 per person (constant 2011 US$). Median CMR was 2.4 deaths per 1,000 persons per year; median U5MR was 18.1 under-5 deaths per 1,000 live births per year. CMR was negatively correlated with total spending ( p =  0.027), and spending for fair protection processes and documentation ( p =  0.005), external relations ( p =  0.034), logistics and operations support ( p =  0.007), and for healthcare ( p =  0.046). U5MR ratio was negatively correlated with total spending ( p =  0.015), and spending for favorable protection environment ( p =  0.024), fair protection processes and documentation ( p =  0.003), basic needs and essential services ( p =  0.027), and within basic needs, for healthcare services ( p =  0.007). Increased UNHCR spending on refugee populations is correlated with lower mortality, likely reflecting unique refugee vulnerabilities and dependence on aid. Future analyses using more granular data can further elucidate the health impact of humanitarian sector spending, thereby guiding policy choices.

On Values, Determinants of Spending, and Civil Rights: Response to Commentaries on Braddock et al.

ERIC Educational Resources Information Center

Braddock, David

1987-01-01

In response to comments on his nationwide study of public mental retardation/developmental disabilities spending in the states, the author considers classification of funds (income maintenance, large private facilities and prisons, nursing homes, and education/vocational rehabilitation), values, determinants, civil rights, and reform. (DB)

Government funding for HIV not keeping pace with epidemic.

PubMed

1999-05-14

In April 1999, UNAIDS warned that government spending has failed to keep up with the global spread of AIDS. Although the U.S. is the largest funder of international AIDS programs among industrialized nations, Norway and the Netherlands ranked first and second, respectively, with respect to the portion of their gross national product spent on these programs. The United States gave only $17 for each $1 million of its gross national product, compared with Norway's $93 and the Netherlands' $92 per $1 million. UNAIDS executive director Peter Piot cautioned that, in order to effectively improve conditions in developing nations, more must be invested in the fight against AIDS.

Immunohistochemical Pitfalls: Common Mistakes in the Evaluation of Lynch Syndrome.

PubMed

Markow, Michael; Chen, Wei; Frankel, Wendy L

2017-12-01

At least 15% of colorectal cancers diagnosed in the United States are deficient in mismatch repair mechanisms. Most of these are sporadic, but approximately 3% of colorectal cancers result from germline alterations in mismatch repair genes and represent Lynch syndrome. It is critical to identify patients with Lynch syndrome to institute appropriate screening and surveillance for patients and their families. Exclusion of Lynch syndrome in sporadic cases is equally important because it reduces anxiety for patients and prevents excessive spending on unnecessary surveillance. Immunohistochemistry is one of the most widely used screening tools for identifying patients with Lynch syndrome. Copyright © 2017 Elsevier Inc. All rights reserved.

The US health care system: Part 1: Our current system.

PubMed

Nuwer, M R; Esper, G J; Donofrio, P D; Szaflarski, J P; Barkley, G L; Swift, T R

2008-12-02

The US health care crisis is of great concern to American neurologists. The United States has the world's most expensive health care system yet one-sixth of Americans are uninsured. The cost and volume of procedures is expanding, while reimbursement for office visits is declining. Pharmaceutical costs, durable goods, and home health care are growing disproportionately to other services. Carriers spend more for their own administration and profit than on payments to physicians. This first article on the US health care system identifies problems and proposes solutions, many of which are championed by the American Academy of Neurology through its legislative and regulatory committees.

Children, adolescents, and the media: health effects.

PubMed

Strasburger, Victor C; Jordan, Amy B; Donnerstein, Ed

2012-06-01

The media can be a powerful teacher of children and adolescents and have a profound impact on their health. The media are not the leading cause of any major health problem in the United States, but they do contribute to a variety of pediatric and adolescent health problems. Given that children and teens spend >7 hours a day with media, one would think that adult society would recognize its impact on young people's attitudes and behaviors. Too little has been done to protect children and adolescents from harmful media effects and to maximize the powerfully prosocial aspects of modern media. Copyright © 2012 Elsevier Inc. All rights reserved.

2017 National Park visitor spending effects : Economic contributions to local communities, states, and the Nation

USGS Publications Warehouse

Cullinane Thomas, Catherine M.; Koontz, Lynne; Cornachione, Egan

2018-01-01

The National Park Service (NPS) manages the Nation’s most iconic destinations that attract millions of visitors from across the Nation and around the world. Trip-related spending by NPS visitors generates and supports a considerable amount of economic activity within park gateway communities. This economic effects analysis measures how NPS visitor spending cycles through local economies, generating business sales and supporting jobs and income. In 2017, the National Park System received an estimated 331 million recreation visits. Visitors to National Parks spent an estimated \\$18.2 billion in local gateway regions (defined as communities within 60 miles of a park). The contribution of this spending to the national economy was 306 thousand jobs, \\$11.9 billion in labor income, \\$20.3 billion in value added, and \\$35.8 billion in economic output. The lodging sector saw the highest direct contributions with \\$5.5 billion in economic output directly contributed to local gateway economies nationally. The sector with the next greatest direct contributions was the restaurants and bars sector, with \\$3.7 billion in economic output directly contributed to local gateway economies nationally. Results from the Visitor Spending Effects report series are available online via an interactive tool. Users can view year-by-year trend data and explore current year visitor spending, jobs, labor income, value added, and economic output effects by sector for national, state, and local economies. This interactive tool is available at https://www.nps.gov/subjects/socialscience/vse.htm.

2016 National Park visitor spending effects: Economic contributions to local communities, states, and the Nation

USGS Publications Warehouse

Cullinane Thomas, Catherine; Koontz, Lynne

2017-01-01

The National Park Service (NPS) manages the Nation’s most iconic destinations that attract millions of visitors from across the Nation and around the world. Trip-related spending by NPS visitors generates and supports a considerable amount of economic activity within park gateway communities. This economic effects analysis measures how NPS visitor spending cycles through local economies, generating business sales and supporting jobs and income.In 2016, the National Park System received an estimated 330,971,689 recreation visits. Visitors to National Parks spent an estimated \\$18.4 billion in local gateway regions (defined as communities within 60 miles of a park). The contribution of this spending to the national economy was 318 thousand jobs, \\$12.0 billion in labor income, \\$19.9 billion in value added, and \\$34.9 billion in economic output. The lodging sector saw the highest direct contributions with \\$5.7 billion in economic output directly contributed to local gateway economies nationally. The sector with the next greatest direct contributions was the restaurants and bars sector, with \\$3.7 billion in economic output directly contributed to local gateway economies nationally.Results from the Visitor Spending Effects report series are available online via an interactive tool. Users can view year-by-year trend data and explore current year visitor spending, jobs, labor income, value added, and economic output effects by sector for national, state, and local economies. This interactive tool is available at https://www.nps.gov/subjects/socialscience/vse.htm.

2015 National Park visitor spending effects: Economic contributions to local communities, states, and the nation

USGS Publications Warehouse

Cullinane Thomas, Catherine M.; Koontz, Lynne

2016-01-01

The National Park Service (NPS) manages the Nation’s most iconic destinations that attract millions of visitors from across the Nation and around the world. Trip-related spending by NPS visitors generates and supports a considerable amount of economic activity within park gateway communities. This economic effects analysis measures how NPS visitor spending cycles through local economies, generating business sales and supporting jobs and income.In 2015, the National Park System received over 307.2 million recreation visits. NPS visitors spent \\$16.9 billion in local gateway regions (defined as communities within 60 miles of a park). The contribution of this spending to the national economy was 295 thousand jobs, \\$11.1 billion in labor income, \\$18.4 billion in value added, and \\$32.0 billion in economic output. The lodging sector saw the highest direct contributions with \\$5.2 billion in economic output directly contributed to local gateway economies nationally. The sector with the next greatest direct contributions was the restaurants and bar sector, with \\$3.4 billion in economic output directly contributed to local gateway economies nationally.Results from the Visitor Spending Effects report series are available online via an interactive tool. Users can view year-by-year trend data and explore current year visitor spending, jobs, labor income, value added, and economic output effects by sector for national, state, and local economies. This interactive tool is available at http://go.nps.gov/vse.

Trends in Hospital Cost and Revenue, 1994–2005: How Are They Related to HMO Penetration, Concentration, and For-Profit Ownership?

PubMed Central

Shen, Yu-Chu; Wu, Vivian Y; Melnick, Glenn

2010-01-01

Objective Analyze trends in hospital cost and revenue, as well as price and quantity (1994–2005) as a function of health maintenance organization (HMO) penetration, HMO concentration, and for-profit (FP) HMO market share. Data Medicare hospital cost reports, AHA Annual Surveys, HMO data from Interstudy, and other supplemental data. Study Design A retrospective study of all short-term, general, nonfederal hospitals in metropolitan statistical areas (MSAs) in the United States from 1994 to 2005, using hospital/MSA fixed-effects translog regression models. Principal Findings A 10 percentage point increase in HMO enrollment is associated with 4.1–4.2 percent reduction in costs and revenues in the pre-2000 period but only a 2.1–2.5 percent reduction in the post-2000 period. Hospital revenue in HMO-dominant markets (highly concentrated HMO market and competitive hospital market) is 19–27 percent lower than other types of markets, and the difference is most likely due mainly to lower prices and to a lesser extent lower utilization. Conclusions The historical difference of lower spending in high HMO penetration markets compared with low HMO markets narrowed after 2000 and the relative concentration between HMO and hospital markets can substantially influence hospital spending. Additional research is needed to understand how different aspects of these two markets have changed and interacted and how they are causally linked to spending trends. PMID:19840134

The neoliberal political economy and erosion of retirement security.

PubMed

Polivka, Larry; Luo, Baozhen

2015-04-01

The origins and trajectory of the crisis in the United States retirement security system have slowly become part of the discussion about the social, political, and economic impacts of population aging. Private sources of retirement security have weakened significantly since 1980 as employers have converted defined benefits precisions to defined contribution plans. The Center for Retirement Research (CRR) now estimates that over half of boomer generation retirees will not receive 70-80% of their wages while working. This erosion of the private retirement security system will likely increase reliance on the public system, mainly Social Security and Medicare. These programs, however, have increasingly become the targets of critics who claim that they are not financially sustainable in their current form and must be significantly modified. This article will focus on an analysis of these trends in the erosion of the United States retirement security system and their connection to changes in the United States political economy as neoliberal, promarket ideology, and policies (low taxes, reduced spending, and deregulation) have become dominant in the private and public sectors. The neoliberal priority on reducing labor costs and achieving maximum shareholder value has created an environment inimical to maintain the traditional system of pension and health care benefits in both the private and public sectors. This article explores the implications of these neoliberal trends in the United States economy for the future of retirement security. © The Author 2015. 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.

Where Do Freestanding Emergency Departments Choose to Locate? A National Inventory and Geographic Analysis in Three States.

PubMed

Schuur, Jeremiah D; Baker, Olesya; Freshman, Jaclyn; Wilson, Michael; Cutler, David M

2017-04-01

We determine the number and location of freestanding emergency departments (EDs) across the United States and determine the population characteristics of areas where freestanding EDs are located. We conducted a systematic inventory of US freestanding EDs. For the 3 states with the highest number of freestanding EDs, we linked demographic, insurance, and health services data, using the 5-digit ZIP code corresponding to the freestanding ED's location. To create a comparison nonfreestanding ED group, we matched 187 freestanding EDs to 1,048 nonfreestanding ED ZIP codes on land and population within state. We compared differences in demographic, insurance, and health services factors between matched ZIP codes with and without freestanding EDs, using univariate regressions with weights. We identified 360 freestanding EDs located in 30 states; 54.2% of freestanding EDs were hospital satellites, 36.6% were independent, and 9.2% were not classifiable. The 3 states with the highest number of freestanding EDs accounted for 66% of all freestanding EDs: Texas (181), Ohio (34), and Colorado (24). Across all 3 states, freestanding EDs were located in ZIP codes that had higher incomes and a lower proportion of the population with Medicaid. In Texas and Ohio, freestanding EDs were located in ZIP codes with a higher proportion of the population with private insurance. In Texas, freestanding EDs were located in ZIP codes that had fewer Hispanics, had a greater number of hospital-based EDs and physician offices, and had more physician visits and medical spending per year than ZIP codes without a freestanding ED. In Ohio, freestanding EDs were located in ZIP codes with fewer hospital-based EDs. In Texas, Ohio, and Colorado, freestanding EDs were located in areas with a better payer mix. The location of freestanding EDs in relation to other health care facilities and use and spending on health care varied between states. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

You and Foreign Money.

ERIC Educational Resources Information Center

Tucker, James F.

Foreign currency units, exchange rates, the international payments process, and spending money abroad are discussed briefly in this booklet to help teachers explain the international economy. Thirty-two countries are listed with their respective currency units, some of which are illustrated. A chart shows the average yearly exchange rates between…

eHealth Search Patterns: A Comparison of Private and Public Health Care Markets Using Online Panel Data

PubMed Central

2017-01-01

Background Patient and consumer access to eHealth information is of crucial importance because of its role in patient-centered medicine and to improve knowledge about general aspects of health and medical topics. Objectives The objectives were to analyze and compare eHealth search patterns in a private (United States) and a public (United Kingdom) health care market. Methods A new taxonomy of eHealth websites is proposed to organize the largest eHealth websites. An online measurement framework is developed that provides a precise and detailed measurement system. Online panel data are used to accurately track and analyze detailed search behavior across 100 of the largest eHealth websites in the US and UK health care markets. Results The health, medical, and lifestyle categories account for approximately 90% of online activity, and e-pharmacies, social media, and professional categories account for the remaining 10% of online activity. Overall search penetration of eHealth websites is significantly higher in the private (United States) than the public market (United Kingdom). Almost twice the number of eHealth users in the private market have adopted online search in the health and lifestyle categories and also spend more time per website than those in the public market. The use of medical websites for specific conditions is almost identical in both markets. The allocation of search effort across categories is similar in both the markets. For all categories, the vast majority of eHealth users only access one website within each category. Those that conduct a search of two or more websites display very narrow search patterns. All users spend relatively little time on eHealth, that is, 3-7 minutes per website. Conclusions The proposed online measurement framework exploits online panel data to provide a powerful and objective method of analyzing and exploring eHealth behavior. The private health care system does appear to have an influence on eHealth search behavior in terms of search penetration and time spent per website in the health and lifestyle categories. Two explanations are offered: (1) the personal incentive of medical costs in the private market incentivizes users to conduct online search; and (2) health care information is more easily accessible through health care professionals in the United Kingdom compared with the United States. However, the use of medical websites is almost identical, suggesting that patients interested in a specific condition have a motivation to search and evaluate health information, irrespective of the health care market. The relatively low level of search in terms of the number of websites accessed and the average time per website raise important questions about the actual level of patient informedness in both the markets. Areas for future research are outlined. PMID:28408362

Evidence of horizontal and vertical interactions in health care spending in the Philippines.

PubMed

Kelekar, Uma; Llanto, Gilberto

2015-09-01

This article examines whether within a decentralized system of health care spending, local government units in developing countries have any incentive to compete with one another. The existence of spatial competition, whether horizontal or vertical, is tested in the case of Philippines using local government health expenditures data. Results indicate that health spending is characterized by a strong positive interaction between municipalities, consistent with the existence of a horizontal fiscal interaction. However, the results provide less support for the existence of vertical externalities, with the interaction of municipalities with provinces being positive and marginally significant. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Mandatory insurance coverage and hospital productivity in Massachusetts: bending the curve?

PubMed

Thompson, Mark A; Huerta, Timothy R; Ford, Eric W

2012-01-01

The aim of this study was to examine whether universal insurance coverage mandates lead to a more productive use of hospital resources. The American Hospital Association's Annual Survey and the Centers for Medicare and Medicaid Services' case mix index for fiscal years 2005 through 2008 were used. A Malmquist approach was used to assess hospitals' productivity in the United States and Massachusetts over the sample period. Propensity score matching is used to "simulate" a randomized control group of hospitals from other markets to compare with Massachusetts. Comparisons are then made to examine if productivity differences are due to universal health insurance coverage mandate. In the early stages, Massachusetts' coverage mandates lead to a significant drop in hospitals' productivity relative to comparable facilities in other states. In 2008, Massachusetts functioned 3.53% below its 2005 level, whereas facilities across the United States have seen a 4.06% increase over the same period. If the individual mandate is implemented nationwide, the Massachusetts' experience indicates that a near-term decrease in overall hospital productivity will occur. As such, current cost estimates of the Patient Protection and Affordable Care Act's impact on overall health spending are potentially understated.

Estimating financial resources for universal access to sexual reproductive health care: Evidence from two states in India.

PubMed

Rout, Sarit Kumar; Pradhan, Jalandhar; Choudhury, Sarmistha

2016-10-01

India has made insignificant progress towards achieving universal access to sexual and reproductive health (SRH). One of the key inputs for achieving universal access to SRH is financial resources. Given this, many international agencies including the UN are emphasising on monitoring the financial progress towards achieving SRH. To generate evidence on spending on SRH from various sources - (government, household, international donors and NGOs) to improve the accountability of the government towards SRH goal. Adapting a sub account framework of the NHA, this paper investigated the SRH expenditure of the two divergent states of India. The data were collected from government, households (NSSO), and foreign donors and were classified as per the International Classification of Health Accounts (ICHA). Total SRH expenditure is less than one percent of SGDP from all sources in each state. Among the sources, government's spending on SRH is more than household. A large part of household spending is on curative care which has implications for accessing services by the poor. In spite of data constraints, this paper presents a comprehensive analysis on SRH spending, which is critical for monitoring the commitment towards universal access to SRH. This evidence can be used for further improving data quality for RCH account in LMICs. Copyright © 2016 Elsevier B.V. All rights reserved.

Gifts and influence: Conflict of interest policies and prescribing of psychotropic medications in the United States.

PubMed

King, Marissa; Bearman, Peter S

2017-01-01

The pharmaceutical industry spends roughly 15 billion dollars annually on detailing - providing gifts, information, samples, trips, honoraria and other inducements - to physicians in order to encourage them to prescribe their drugs. In response, several states in the United States adopted policies that restrict detailing. Some states banned gifts from pharmaceutical companies to doctors, other states simply required physicians to disclose the gifts they receive, while most states allowed unrestricted detailing. We exploit this geographic variation to examine the relationship between gift regulation and the diffusion of four newly marketed medications. Using a dataset that captures 189 million psychotropic prescriptions written between 2005 and 2009, we find that uptake of new costly medications was significantly lower in states with marketing regulation than in areas that allowed unrestricted pharmaceutical marketing. In states with gift bans, we observed reductions in market shares ranging from 39% to 83%. Policies banning or restricting gifts were associated with the largest reductions in uptake. Disclosure policies were associated with a significantly smaller reduction in prescribing than gift bans and gift restrictions. In states that ban gift-giving, peer influence substituted for pharmaceutical detailing when a relatively beneficial drug came to market and provided a less biased channel for physicians to learn about new medications. Our work suggests that policies banning or limiting gifts from pharmaceutical representatives to doctors are likely to be more effective than disclosure policies alone. Copyright © 2016 Elsevier Ltd. All rights reserved.

Gifts and influence: Conflict of interest policies and prescribing of psychotropic medications in the United States

PubMed Central

King, Marissa; Bearman, Peter S.

2016-01-01

The pharmaceutical industry spends roughly 15 billion dollars annually on detailing – providing gifts, information, samples, trips, honoraria and other inducements – to physicians in order to encourage them to prescribe their drugs. In response, several states in the United States adopted policies that restrict detailing. Some states banned gifts from pharmaceutical companies to doctors, other states simply required physicians to disclose the gifts they receive, while most states allowed unrestricted detailing. We exploit this geographic variation to examine the relationship between gift regulation and the diffusion of four newly marketed medications. Using a dataset that captures 189 million psychotropic prescriptions written between 2005 and 2009, we find that uptake of new costly medications was significantly lower in states with marketing regulation than in areas that allowed unrestricted pharmaceutical marketing. In states with gift bans, we observed reductions in market shares ranging from 39% to 83%. Policies banning or restricting gifts were associated with the largest reductions in uptake. Disclosure policies were associated with a significantly smaller reduction in prescribing than gift bans and gift restrictions. In states that ban gift-giving, peer influence substituted for pharmaceutical detailing when a relatively beneficial drug came to market and provided a less biased channel for physicians to learn about new medications. Our work suggests that policies banning or limiting gifts from pharmaceutical representatives to doctors are likely to be more effective than disclosure policies alone. PMID:27856120

An Update on Asset Management Plans in the United Kingdom.

ERIC Educational Resources Information Center

Patel, Mukund

1999-01-01

Describes a current project in the United Kingdom designed to improve school buildings. The use of Asset Management Plans (AMPs) in providing the means through which likely future needs are assessed, criteria for prioritization are set, and informed decisions on local spending are made are examined. (GR)

The relationship between state capacity measures and allocations to children and youth with special needs within the MCH Services Block Grant.

PubMed

Margolis, Lewis H; Mayer, Michelle; Clark, Kathryn A; Farel, Anita M

2009-07-01

To examine the association between state economic, political and health services capacity and state allocations for Title V capacity for Children and Youth with Special Health Care Needs (CSHCN). Numerous datasets were reviewed to select 13 state capacity measures: per capita Gross State Product (economic); governor's institutional powers and legislative professionalism (political); percent of Children with Special Health Care Needs, percent of uninsured children, percent of children enrolled in Medicaid, state health funds as a percent of Gross State Product, ratio of Medicaid to Medicare fees, percent of children in Medicaid enrolled in managed care, per capita Medicaid expenditures for children, ratios of pediatricians/family practitioners and pediatric subspecialists per 10,000 children, and categorical versus functional state definition of CSHCN (health). Five measures of Title V capacity were selected from the Title V Information System, four that reflect allocation decisions by states and the fifth a state assessment of the role of families in Title V decision-making: ratio of state/federal Title V spending; per capita state Title V spending; percent of state Title V spending on CSHCN; state per child spending on CSHCN; and, state Title V Family Participation Score. OLS regression was used to model the association between state and Title V capacity measures. The percentage of the state's gross state product (GSP) accounted for by state health funds and the per capita GSP were positively associated with the per capita expenditures on all children. The percentage of CSHCN in the state was negatively associated with the ratio of state to federal support for Title V and the per child expenditures on CSHCN. Lower family participation scores were associated with having a hybrid legislature; however, higher family participation scores were found in states using a functional definition of special needs. Measures of state economic, political and health services capacity do not demonstrate consistent and significant associations with the Title V capacity measures that we explored. States with greater economic capacity appear to devote more financial resources to Title V. Our finding that per capita CSHCN expenditures are negatively associated with the percentage of CSHCN in the state suggests that there is an upper limit on what states devote to CSHCN. Our current understanding of what state factors influence Title V capacity remains limited.

Linking Quality and Spending to Measure Value for People with Serious Illness.

PubMed

Ryan, Andrew M; Rodgers, Phillip E

2018-03-01

Healthcare payment is rapidly evolving to reward value by measuring and paying for quality and spending performance. Rewarding value for the care of seriously ill patients presents unique challenges. To evaluate the state of current efforts to measure and reward value for the care of seriously ill patients. We performed a PubMed search of articles related to (1) measures of spending for people with serious illness and (2) linking spending and quality measures and rewarding performance for the care of people with serious illness. We limited our search to U.S.-based studies published in English between January 1, 1960, and March 31, 2017. We supplemented this search by identifying public programs and other known initiatives that linked quality and spending for the seriously ill and extracted key program elements. Our search related to linking spending and quality measures and rewarding performance for the care of people with serious illness yielded 277 articles. We identified three current public programs that currently link measures of quality and spending-or are likely to within the next few years-the Oncology Care Model; the Comprehensive End-Stage Renal Disease Model; and Home Health Value-Based Purchasing. Models that link quality and spending consist of four core components: (1) measuring quality, (2) measuring spending, (3) the payment adjustment model, and (4) the linking/incentive model. We found that current efforts to reward value for seriously ill patients are targeted for specific patient populations, do not broadly encourage the use of palliative care, and have not closely aligned quality and spending measures related to palliative care. We develop recommendations for policymakers and stakeholders about how measures of spending and quality can be balanced in value-based payment programs.

Timber management opportunities in Pennsylvania

Treesearch

Henry H. Webster

1960-01-01

The Pennsylvania Department of Forests and Waters serves the people in managing state forest lands and in helping private owners manage their forest lands. To produce more timber from Pennsylvania forests, the Department applies many different forestry practices. But the more effort it spends in one direction, the less it can spend in others. So the Department must...

Systemic Inequities in Special Education Financing

ERIC Educational Resources Information Center

Conlin, Michael; Jalilevand, Meg

2015-01-01

Since the implementation of IDEA in 1975, as spending on education has continued to grow, a large portion of that spending has been dedicated to students with special needs. This study uses a panel dataset of local and intermediate school districts to examine the complex special education funding and delivery scheme in the State of Michigan. Using…

There Is Space to Play! Mexican American Children of Immigrants Learning With(in) Cherry Orchards

ERIC Educational Resources Information Center

Morales, María Isabel

2016-01-01

While some children spend their summers in camps or other recreational activities, many children of immigrants in Washington state spend them picking cherries and learning with(in) orchards. Children's experiences consist of multiple narratives demonstrating that children's lives are complicated, yet full of possibilities for teaching and…

Occupational Therapy in Medicaid Home and Community-Based Services Waivers.

PubMed

Friedman, Carli; VanPuymbrouck, Laura

Medicaid Home and Community-Based Services (HCBS) 1915(c) waivers are the largest provider of long-term services and supports for people with intellectual and developmental disabilities (IDDs). In this study, we explored how HCBS IDD waivers projected providing occupational therapy services in Fiscal Year (FY) 2015. Medicaid HCBS IDD waivers across the nation gathered from the Centers for Medicare and Medicaid Services were qualitatively and quantitatively analyzed to determine how they projected providing occupational therapy services in terms of service expenditures and utilization. In FY 2015, $14.13 million of spending was projected for occupational therapy services of 7,500 participants. However, there was large heterogeneity across states and services in terms of total projected spending, spending per participant, and reimbursement rates. Comparisons across states strengthen the profession's ability to assert the value of its services. These findings can help identify best practices and can advocate for the refinement of state occupational therapy programs. Copyright © 2018 by the American Occupational Therapy Association, Inc.

Occupational Therapy in Medicaid Home and Community-Based Services Waivers

PubMed Central

VanPuymbrouck, Laura

2018-01-01

OBJECTIVE. Medicaid Home and Community-Based Services (HCBS) 1915(c) waivers are the largest provider of long-term services and supports for people with intellectual and developmental disabilities (IDDs). In this study, we explored how HCBS IDD waivers projected providing occupational therapy services in Fiscal Year (FY) 2015. METHOD. Medicaid HCBS IDD waivers across the nation gathered from the Centers for Medicare and Medicaid Services were qualitatively and quantitatively analyzed to determine how they projected providing occupational therapy services in terms of service expenditures and utilization. RESULTS. In FY 2015, $14.13 million of spending was projected for occupational therapy services of 7,500 participants. However, there was large heterogeneity across states and services in terms of total projected spending, spending per participant, and reimbursement rates. CONCLUSION. Comparisons across states strengthen the profession’s ability to assert the value of its services. These findings can help identify best practices and can advocate for the refinement of state occupational therapy programs. PMID:29426389

Determinants of states' allocations of the master settlement agreement payments.

PubMed

Sloan, Frank A; Carlisle, Emily Streyer; Rattliff, John R; Trogdon, Justin

2005-08-01

To determine which factors influence states' allocation decisions for the tobacco Master Settlement Agreement and the four individual settlements' annual payments, including the decision to securitize, we analyzed the effects of voter characteristics, political parties, interest groups, prior spending on public tobacco control programs, and state fiscal health on per capita settlement funds allocated to tobacco-control, health, and other programs. Tobacco-producing states and those with high proportions of conservative Democrats or elderly, black, Hispanic, or wealthy people tended to spend less on tobacco control. Education and medical lobbies had strong positive influences on per capita allocations for tobacco-control and health-related programs. State fiscal crises affected amounts spent by states from settlement funds as well as the probability of securitizing future cash flows from the settlements.

The Cost-Effectiveness of Vedolizumab for Inflammatory Bowel Disease: A Review of the Current Literature

PubMed Central

Saumoy, Monica; Cohen-Mekelburg, Shirley; Steinlauf, Adam F.; Scherl, Ellen J.

2016-01-01

The United States spends a greater share per gross domestic product on health care than any other developed country in the world. Cost-conscious, high-value care has an important role in the practice of medicine. Inflammatory bowel disease (IBD) affects 1.6 million people in the United States and is responsible for significant health care costs, with estimates as high as $31.6 billion annually, a large portion of which is attributable to the use of biologic therapies. As the number of therapeutic targets for IBD expands, gastroenterologists can anticipate the arrival of novel therapeutic agents on the market, and these may carry significant costs. Vedolizumab, a monoclonal antibody directed against the gut-selective integrin α4β7, is a novel biologic agent approved for the treatment of Crohn’s disease and ulcerative colitis. Cost-effectiveness is an area of research that aims to assess the added value (in terms of both cost and utility) of diagnostic or therapeutic interventions. This article reviews the current literature evaluating the cost-effectiveness of vedolizumab for the treatment of IBD. PMID:27917076

Living Together Apart in France and the United States

PubMed Central

Martin, Claude; Cherlin, Andrew; Cross-Barnet, Caitlin

2014-01-01

Union formation involves a number of stages, as does union dissolution, and new couples often spend an initial period in a non-cohabiting intimate relationship. Yet while certain couples never share the same dwelling, “living apart together”1 has not developed widely as a long-term lifestyle option. Claude Martin in France, and Andrew Cherlin and Caitlin Cross-Barnet in the United States have studied a symmetrical phenomenon, that of couples who continue to live together while considering themselves to be separated. In this article, they draw together their analyses to describe an arrangement which, while marginal, reveals situations where residential separation is not possible, either because of the need to keep up appearances, often for the children’s sake, or because total separation is too frightening or living in separate homes is unaffordable. Beyond the differences between the two countries and the two survey fields, the authors analyse the ways in which persons who “live together apart” describe their loveless relationship that has led to explicit conjugal separation within a shared home. PMID:25170338

Facts, fallacies, and politics of comparative effectiveness research: Part 2 - implications for interventional pain management.

PubMed

Manchikanti, Laxmaiah; Falco, Frank J E; Boswell, Mark V; Hirsch, Joshua A

2010-01-01

The United States leads the world in many measures of health care innovation. However, it has been criticized to lag behind many developed nations in important health outcomes including mortality rates and higher health care costs. The surveys have shown the United States to outspend all other Organisation for Economic Co-operation and Development (OECD) countries with spending on health goods and services per person of $7,290 - almost 2(1/2) times the average of all OECD countries in 2007. Rising health care costs in the United States have been estimated to increase to 19.1% of gross domestic product (GDP) or $4.4 trillion by 2018. CER is defined as the generation and synthesis of evidence that compares the benefits and harms of alternate methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care. The, comparative effectiveness research (CER) has been touted by supporters with high expectations to resolve most ill effects of health care in the United States providing high quality, less expensive, universal health care. The efforts of CER in the United States date back to the late 1970s and it was officially inaugurated with the enactment of the Medicare Modernization Act (MMA). It has been rejuvenated with the American Recovery and Reinvestment Act (ARRA) of 2009 with an allocation of $1.1 billion. CER has been the basis of decision for health care in many other countries. Of all the available agencies, the National Institute for Health and Clinical Excellence (NICE) of the United Kingdom is the most advanced, stable, and has provided significant evidence, though based on rigid and proscriptive economic and clinical formulas. While CER is taking a rapid surge in the United States, supporters and opponents are emerging expressing their views. Since interventional pain management is a new and evolving specialty, with ownership claimed by numerous organizations, at times it is felt as if it has many fathers and other times it becomes an orphan. Part 2 of this comprehensive review will provide facts, fallacies, and politics of CER along with discussion of potential outcomes, impact of CER on health care delivery, and implications for interventional pain management in the United States.

Car indoor air pollution - analysis of potential sources

PubMed Central

2011-01-01

The population of industrialized countries such as the United States or of countries from the European Union spends approximately more than one hour each day in vehicles. In this respect, numerous studies have so far addressed outdoor air pollution that arises from traffic. By contrast, only little is known about indoor air quality in vehicles and influences by non-vehicle sources. Therefore the present article aims to summarize recent studies that address i.e. particulate matter exposure. It can be stated that although there is a large amount of data present for outdoor air pollution, research in the area of indoor air quality in vehicles is still limited. Especially, knowledge on non-vehicular sources is missing. In this respect, an understanding of the effects and interactions of i.e. tobacco smoke under realistic automobile conditions should be achieved in future. PMID:22177291

Mean Recency Period for Estimation of HIV-1 Incidence with the BED-Capture EIA and Bio-Rad Avidity in Persons Diagnosed in the United States with Subtype B.

PubMed

Hanson, Debra L; Song, Ruiguang; Masciotra, Silvina; Hernandez, Angela; Dobbs, Trudy L; Parekh, Bharat S; Owen, S Michele; Green, Timothy A

2016-01-01

HIV incidence estimates are used to monitor HIV-1 infection in the United States. Use of laboratory biomarkers that distinguish recent from longstanding infection to quantify HIV incidence rely on having accurate knowledge of the average time that individuals spend in a transient state of recent infection between seroconversion and reaching a specified biomarker cutoff value. This paper describes five estimation procedures from two general statistical approaches, a survival time approach and an approach that fits binomial models of the probability of being classified as recently infected, as a function of time since seroconversion. We compare these procedures for estimating the mean duration of recent infection (MDRI) for two biomarkers used by the U.S. National HIV Surveillance System for determination of HIV incidence, the Aware BED EIA HIV-1 incidence test (BED) and the avidity-based, modified Bio-Rad HIV-1/HIV-2 plus O ELISA (BRAI) assay. Collectively, 953 specimens from 220 HIV-1 subtype B seroconverters, taken from 5 cohorts, were tested with a biomarker assay. Estimates of MDRI using the non-parametric survival approach were 198.4 days (SD 13.0) for BED and 239.6 days (SD 13.9) for BRAI using cutoff values of 0.8 normalized optical density and 30%, respectively. The probability of remaining in the recent state as a function of time since seroconversion, based upon this revised statistical approach, can be applied in the calculation of annual incidence in the United States.

National Health Expenditures, 19801

PubMed Central

Gibson, Robert M.; Waldo, Daniel R.

1981-01-01

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

National Health Expenditures, 19811

PubMed Central

Gibson, Robert M.; Waldo, Daniel R.

1982-01-01

The United States spent an estimated $287 billion for health care in 1981 (Figure 1), an amount equal to 9.8 percent of the Gross National Product (GNP). Highlights of the figures that underly this estimate include the following: Health care expenditures continued to grow at a rapid rate in 1981, at a time when the economy as a whole exhibited sluggish growth. The 9.8 percent share of the GNP was a dramatic increase from the 8.9 percent share seen just two years earlier.Health care expenditures amounted to $1,225 per person in 1981 (Table 1). Of that amount, $524, or 42.7 percent, came from public funds.Hospital care accounted for 41.2 percent of total health care spending in 1981 (Table 2). These expenditures increased 17.5 percent from 1980, to a level of $118 billion.Spending for the services of physicians increased 16.9 percent to $55 billion—19.1 percent of all health care spending.Public sources provided 42.7 percent of the money spent on health in 1981, including Federal payments of $84 billion and $39 billion in State and local government funds (Table 3).All third parties combined—private health insurers, governments, private charities, and Industry—financed 67.9 percent of the $255 billion in personal health care in 1981 (Table 4), covering 89.2 percent of hospital care services, 62.1 percent of physicians' services, and 41.3 percent of the remainder (Table 5).Direct patient payments for health care reached $82 billion in 1981, accounting for 32.1 percent of all personal health care expenses (Table 6). Consumers and their employers paid another $73 billion in premiums to private health insurers, $67 billion of which was returned in the form of benefits.Outlays for health care benefits by the Medicare and Medicaid programs totaled $73 billion, including $42 billion for hospital care. The two programs combined paid for 28.6 percent of all personal health care in the nation (Table 7). PMID:10309718

Financing Education for the Public Good: A New Strategy

ERIC Educational Resources Information Center

McMahon, Walter W.

2015-01-01

A new approach is suggested that depends on and measures how spending on higher and basic education is really an investment in the future, not consumption spending. This is a vital distinction because investment in human capital contributes heavily to growth and development, but also to higher state tax revenue and lower Medicaid, child care,…

40 CFR 35.4070 - How can my group spend TAG money?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 1 2010-07-01 2010-07-01 false How can my group spend TAG money? 35.4070 Section 35.4070 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GRANTS AND OTHER FEDERAL ASSISTANCE STATE AND LOCAL ASSISTANCE Grants for Technical Assistance What Tags Can Pay For § 35.4070 How can...

Rationalizing IT Rationing: 10 Ways to Cut the IT Budget (and What Not to Cut)

ERIC Educational Resources Information Center

Miller, Fred

2009-01-01

Whether because of falling stock values affecting institutional endowments, cutbacks in state spending, or declines in private giving, higher education has reduced spending, and information technology (IT) organizations have participated in the budget cuts. This is the tale of one institution's quest to cut technology costs while maintaining a…

Well "and" Well-Off: Decreasing Medicaid and Health-Care Costs by Increasing Educational Attainment

ERIC Educational Resources Information Center

DeBaun, Bill; Roc, Martens

2013-01-01

Cutting the number of high school dropouts in half nationally would save $7.3 billion in annual Medicaid spending, according to a new report from the Alliance for Excellent Education. "Well 'and' Well-Off: Decreasing Medicaid and Health-Care Costs by Increasing Educational Attainment" examines Medicaid spending for all fifty states and…

How Newspaper Advertising Sales Managers Spend Their Time: A Pilot Study.

ERIC Educational Resources Information Center

Hudson, Jerry C.; Saathoff, Roger C.

A pilot study examined how newspaper advertising sales managers in five southwestern states spend their time during a typical work day. Of the 360 questionnaires mailed, 176 responses were received. The largest number of responses (93) came from retail sales managers of newspapers in markets with less than 50,000 population. The questionnaire…

Behavioral Economic Indicators of Drinking Problem Severity and Initial Outcomes Among Problem Drinkers Attempting Natural Recovery: A Cross-sectional Naturalistic Study

PubMed Central

Tucker, Jalie A.; Cheong, JeeWon; Chandler, Susan D.; Lambert, Brice H.; Kwok, Heather; Pietrzak, Brittney

2016-01-01

Background and aims Research using different behavioral economic (BE) and time perspective (TP) measures suggests that substance misusers show greater sensitivity to shorter term contingencies than normal controls, but multiple measures have seldom been investigated together. This study evaluated the extent to which multiple BE and TP measures were associated with drinking problem severity, distinguished initial outcomes of natural recovery attempts, and shared common variance. Hypotheses were (1) greater problem severity would be associated with greater impulsivity and demand for alcohol and shorter TPs; and (2) low-risk drinking would be associated with greater sensitivity to longer term contingencies compared with abstinence. Design Cross-sectional naturalistic field study. Setting Southern United States. Participants Problem drinkers, recently resolved without treatment (N = 191 [76.4% male], M age = 50.1 years) recruited using media advertisements. Measurements Drinking practices, dependence levels, and alcohol-related problems prior to stopping problem drinking were assessed during structured field interviews. Measures included the Zimbardo Time Perspective Inventory; BE analogue choice tasks (Delay Discounting [DD], Melioration-Maximization [MM], Alcohol Purchase Task [APT]); and the Alcohol-Savings Discretionary Expenditure (ASDE) index, derived from real spending on alcohol and voluntary savings during the year before problem cessation. Findings Measures of demand based on real (ASDE) and hypothetical (APT) spending on alcohol were associated with problem severity (ps < .05), but DD, MM, and TP measures were not. More balanced pre-resolution spending on alcohol versus saving for the future distinguished low-risk drinking from abstinent resolutions (ASDE OR = 5.59; p < .001). BE measures did not share common variance. Conclusions Two behavioural assessment tools that measure spending on alcohol, the Alcohol Purchase Task and the Alcohol-Savings Discretionary Expenditure index, appear to be reliable in assessing the severity of drinking problems. The ASDE index also may aid choices between low-risk and abstinent drinking goals. PMID:27318078

Making Research Matter Comment on "Public Spending on Health Service and Policy Research in Canada, the United Kingdom, and the United States: A Modest Proposal".

PubMed

Hunter, David J; Frank, John

2017-08-13

We offer a UK-based commentary on the recent "Perspective" published in IJHPM by Thakkar and Sullivan. We are sympathetic to the authors' call for increased funding for health service and policy research (HSPR). However, we point out that increasing that investment - in any of the three countries they compare: Canada, the United States and the United Kingdom- will ipso facto not necessarily lead to any better use of research by health system decision-makers in these settings. We cite previous authors' descriptions of the many factors that tend to make the worlds of researchers and decision-makers into "two solitudes." And we call for changes in the structure and funding of HSPR, particularly the incentives now in place for purely academic publishing, to tackle a widespread reality: most published research in HSPR, as in other applied fields of science, is never read or used by the vast majority of decision-makers, working out in the "real world. © 2018 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.