76 FR 2453 - Medicare Program; Hospital Inpatient Value-Based Purchasing Program

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-13

... requirements under the Hospital IQR program in the FY 2006 IPPS final rule (70 FR 47420). C. Hospital Inpatient... it was amended by section 3001(a)(2)(C) of the Affordable Care Act, required that the Secretary... discharge of 1%, as required by section 1886(o)(7). Section 1886(o)(1)(C) provides that the Hospital VBP...

Value-based payment in implementing evidence-based care: the Mental Health Integration Program in Washington state.

PubMed

Bao, Yuhua; McGuire, Thomas G; Chan, Ya-Fen; Eggman, Ashley A; Ryan, Andrew M; Bruce, Martha L; Pincus, Harold Alan; Hafer, Erin; Unützer, Jürgen

2017-01-01

To assess the role of value-based payment (VBP) in improving fidelity and patient outcomes in community implementation of an evidence-based mental health intervention, the Collaborative Care Model (CCM). Retrospective study based on a natural experiment. We used the clinical tracking data of 1806 adult patients enrolled in a large implementation of the CCM in community health clinics in Washington state. VBP was initiated in year 2 of the program, creating a natural experiment. We compared implementation fidelity (measured by 3 process-of-care elements of the CCM) between patient-months exposed to VBP and patient-months not exposed to VBP. A series of regressions were estimated to check robustness of findings. We estimated a Cox proportional hazard model to assess the effect of VBP on time to achieving clinically significant improvement in depression (measured based on changes in depression symptom scores over time). Estimated marginal effects of VBP on fidelity ranged from 9% to 30% of the level of fidelity had there been no exposure to VBP (P <.05 for every fidelity measure). Improvement in fidelity in response to VBP was greater among providers with a larger patient panel and among providers with a lower level of fidelity at baseline. Exposure to VBP was associated with an adjusted hazard ratio of 1.45 (95% confidence interval, 1.04-2.03) for achieving clinically significant improvement in depression. VBP improved fidelity to key elements of the CCM, both directly incentivized and not explicitly incentivized by the VBP, and improved patient depression outcomes.

Values-based practice in mental health and psychiatry.

PubMed

Woodbridge-Dodd, Kim

2012-11-01

Values-based practice (VBP) challenges traditions of clinical practice and moral decision-making and the literature published over the last 18 months demonstrates a growing momentum for its use. The VBP model has become part of the narrative of health and social care practice. It features in a range of publications and has been subject to philosophical analysis in relation to its theoretical rigour, and applied to clinical practice through education and training, implementation in the field and policy development. From a philosophical perspective the model faces several challenges; from a practice perspective it is welcomed as a necessary partner to Evidence-Based Practice. Both perspectives suggest VBP requires significant adjustment to professional ideas of good practice, expectations of the clinician service user relationship and notions of what constitutes good care. VBP is both a solution and a problem for clinicians. Whether VBP is seen as providing a much needed clinical skill for working with the complexity of mental health and psychiatry which is steeped in values or a solution to a dominant sociopolitical neoliberal ideology demand for choice and personalization of care, VBP will require clinicians to make personal changes to their values base that reach to the depths of their professional identity.

Implementing Value-Based Payment Reform: A Conceptual Framework and Case Examples.

PubMed

Conrad, Douglas A; Vaughn, Matthew; Grembowski, David; Marcus-Smith, Miriam

2016-08-01

This article develops a conceptual framework for implementation of value-based payment (VBP) reform and then draws on that framework to systematically examine six distinct multi-stakeholder coalition VBP initiatives in three different regions of the United States. The VBP initiatives deploy the following payment models: reference pricing, "shadow" primary care capitation, bundled payment, pay for performance, shared savings within accountable care organizations, and global payment. The conceptual framework synthesizes prior models of VBP implementation. It describes how context, project objectives, payment and care delivery strategies, and the barriers and facilitators to translating strategy into implementation affect VBP implementation and value for patients. We next apply the framework to six case examples of implementation, and conclude by discussing the implications of the case examples and the conceptual framework for future practice and research. © The Author(s) 2015.

Convergence of decision rules for value-based pricing of new innovative drugs.

PubMed

Gandjour, Afschin

2015-04-01

Given the high costs of innovative new drugs, most European countries have introduced policies for price control, in particular value-based pricing (VBP) and international reference pricing. The purpose of this study is to describe how profit-maximizing manufacturers would optimally adjust their launch sequence to these policies and how VBP countries may best respond. To decide about the launching sequence, a manufacturer must consider a tradeoff between price and sales volume in any given country as well as the effect of price in a VBP country on the price in international reference pricing countries. Based on the manufacturer's rationale, it is best for VBP countries in Europe to implicitly collude in the long term and set cost-effectiveness thresholds at the level of the lowest acceptable VBP country. This way, international reference pricing countries would also converge towards the lowest acceptable threshold in Europe.

Patient Hospital Experience Improved Modestly, But No Evidence Medicare Incentives Promoted Meaningful Gains.

PubMed

Papanicolas, Irene; Figueroa, José F; Orav, E John; Jha, Ashish K

2017-01-01

The Centers for Medicare and Medicaid Services (CMS) has played a leading role in efforts to improve patients' experiences with hospital care. Yet little is known about how much patient experience has changed over the past decade, and even less is known about the impact of CMS's most recent strategy: tying payments to performance under the Value-Based Purchasing (VBP) program. We examined trends in multiple measures of patient satisfaction in the period 2008-14. We found that patient experience has improved modestly at US hospitals-both those participating in the VBP program and others-with the majority of improvement concentrated in the period before the program was implemented. While certain subsets of hospitals improved more than others, we found no evidence that the program has had a beneficial effect. As policy makers continue to promote value-based payment as a way to improve patient experience, it will be critical to ensure that payment is structured in ways that actually drive improvement. Project HOPE—The People-to-People Health Foundation, Inc.

Operationalizing value-based pricing of medicines : a taxonomy of approaches.

PubMed

Sussex, Jon; Towse, Adrian; Devlin, Nancy

2013-01-01

The UK Government is proposing a novel form of price regulation for branded medicines, which it has dubbed 'value-based pricing' (VBP). The specifics of how VBP will work are unclear. We provide an account of the possible means by which VBP of medicines might be operationalized, and a taxonomy to describe and categorize the various approaches. We begin with a brief discussion of the UK Government's proposal for VBP and proceed to define a taxonomy of approaches to VBP. The taxonomy has five main dimensions: (1) what is identified as being of value, (2) how each element is measured, (3) how it is valued, (4) how the different elements of value are aggregated, and (5) how the result is then used to determine the price of a medicine. We take as our starting point that VBP will include a measure of health gain and that, as proposed by the UK Government, this will be built on the QALY. Our principal interest is in the way criteria other than QALYs are taken into account, including severity of illness, the extent of unmet need, and wider societal considerations such as impacts on carers. We set out to: (1) identify and describe the full range of alternative means by which 'value' might be measured and valued, (2) identify and describe the options available for aggregating the different components of value to establish a maximum price, and (3) note the challenges and relative advantages associated with these approaches. We review the means by which aspects of VBP are currently operationalized in a selection of countries and place these, and proposals for the UK, in the context of our taxonomy. Finally, we give an initial assessment of the challenges, pros and cons of each approach. We conclude that identifying where VBP should lie on each of the five dimensions entails value judgements: there are no simple 'right or wrong' solutions. If a wider definition of value than incremental QALYs gained is adopted, as is desirable, then a pragmatic way to aggregate the different elements of value, including both QALYs and benefits unrelated to QALYs, is to use a multi-criteria decision analysis (MCDA) approach. All approaches to VBP ultimately require the conversion of value, however assessed, into a monetary price. This requires assessment of the marginal values of all types of benefit, not just of QALYs. All stages of the VBP process are subject to uncertainty and margins of error. Consequently, the assessment of overall value can provide bounds to a price negotiation but cannot be expected to identify a precise value-based price.

California safety-net hospitals likely to be penalized by ACA value, readmission, and meaningful-use programs.

PubMed

Gilman, Matlin; Adams, E Kathleen; Hockenberry, Jason M; Wilson, Ira B; Milstein, Arnold S; Becker, Edmund R

2014-08-01

The Affordable Care Act includes provisions to increase the value obtained from health care spending. A growing concern among health policy experts is that new Medicare policies designed to improve the quality and efficiency of hospital care, such as value-based purchasing (VBP), the Hospital Readmissions Reduction Program (HRRP), and electronic health record (EHR) meaningful-use criteria, will disproportionately affect safety-net hospitals, which are already facing reduced disproportionate-share hospital (DSH) payments under both Medicare and Medicaid. We examined hospitals in California to determine whether safety-net institutions were more likely than others to incur penalties under these programs. To assess quality, we also examined whether mortality outcomes were different at these hospitals. Our study found that compared to non-safety-net hospitals, safety-net institutions had lower thirty-day risk-adjusted mortality rates in the period 2009-11 for acute myocardial infarction, heart failure, and pneumonia and marginally lower adjusted Medicare costs. Nonetheless, safety-net hospitals were more likely than others to be penalized under the VBP program and the HRRP and more likely not to meet EHR meaningful-use criteria. The combined effects of Medicare value-based payment policies on the financial viability of safety-net hospitals need to be considered along with DSH payment cuts as national policy makers further incorporate performance measures into the overall payment system. Project HOPE—The People-to-People Health Foundation, Inc.

'What the patient wants': an investigation of the methods of ascertaining patient values in evidence-based medicine and values-based practice.

PubMed

Wieten, Sarah

2018-02-01

Evidence-Based Medicine (EBM), Values-Based Practice (VBP) and Person-Centered Healthcare (PCH) are all concerned with the values in play in the clinical encounter. However, these recent movements are not in agreement about how to discover these relevant values. In some parts of EBM textbooks, the prescribed method for discovering values is through social science research on the average values in a particular population. VBP by contrast always investigates the individually held values of the different stakeholders in the particular clinical encounter, although the account has some other difficulties. I argue that although average values for populations might be very useful in informing questions of resource distribution and policy making, their use cannot replace the individual solicitation of patient (and other stakeholder) values in the clinical encounter. Because of the inconsistency of the EBM stance on values, the incompatibility of some versions of the EBM treatment of values with PCH, and EBM's attempt to transplant research methods from science into the realm of values, I must recommend the use of the VBP account of values discovery. © 2015 John Wiley & Sons, Ltd.

Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Organ Procurement Organization Reporting and Communication; Transplant Outcome Measures and Documentation Requirements; Electronic Health Record (EHR) Incentive Programs; Payment to Nonexcepted Off-Campus Provider-Based Department of a Hospital; Hospital Value-Based Purchasing (VBP) Program; Establishment of Payment Rates Under the Medicare Physician Fee Schedule for Nonexcepted Items and Services Furnished by an Off-Campus Provider-Based Department of a Hospital. Final rule with comment period and interim final rule with comment period.

PubMed

2016-11-14

This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2017 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program. Further, in this final rule with comment period, we are making changes to tolerance thresholds for clinical outcomes for solid organ transplant programs; to Organ Procurement Organizations (OPOs) definitions, outcome measures, and organ transport documentation; and to the Medicare and Medicaid Electronic Health Record Incentive Programs. We also are removing the HCAHPS Pain Management dimension from the Hospital Value-Based Purchasing (VBP) Program. In addition, we are implementing section 603 of the Bipartisan Budget Act of 2015 relating to payment for certain items and services furnished by certain off-campus provider-based departments of a provider. In this document, we also are issuing an interim final rule with comment period to establish the Medicare Physician Fee Schedule payment rates for the nonexcepted items and services billed by a nonexcepted off-campus provider-based department of a hospital in accordance with the provisions of section 603.

A case study of ex ante, value-based price and reimbursement decision-making: TLV and rimonabant in Sweden.

PubMed

Persson, Ulf; Willis, Michael; Odegaard, Knut

2010-04-01

Value-based pricing (VBP) is a method of setting prices for products based on perceived benefits to the consumer. When information is symmetric and freely available and agency is perfect, VBP is efficient and desirable. Because of substantial information asymmetries, medical insurance distortions, and the prescribing monopoly of physicians, VBP is rare for prescription drugs, though a number of countries have recently moved in this direction. Because the potential benefits can be sizable, it is high time for a review of actual VBP-based decision-making in practice. Sweden, with its pharmaceutical benefits board (TLV), was an early adopter of VBP decision-making. We illustrate actual decision-making, thus, using the case of Acomplia for the treatment of obesity in Sweden, with and without the presence of co-morbid conditions. This example has a number of features that will be useful in illustrating the strengths and weaknesses of VBP in actual practice, including multiple indications, a need for not just one but two economic simulation models, considerable sub-group analysis, and requirements for additional evidence development. TLV concluded, in 2006, that Acomplia was cost-effective for patients with a body mass index (BMI) exceeding 35 kg/m2 and patients with a BMI exceeding 28 kg/m2 and either dyslipidemia or type 2 diabetes. Because of uncertainty in some of the underlying assumptions, reimbursement was granted only until 31 December 2008, at which time the manufacturer would be required to submit additional documentation of the long-term effects and cost-effectiveness in order to obtain continued reimbursement. Deciding on reimbursement coverage for pharmaceutical products is difficult. Ex ante VBP assessment is a form of risk sharing, which has been used by TLV to speed up reimbursement and dispersion of effective new drugs despite uncertainty in their true cost-effectiveness. Manufacturers are often asked in return to generate additional health economic evidence that will establish cost-effectiveness as part of ex post review. The alternative is to delay the reimbursement approval until satisfactory evidence is available.

Medicare Payment Penalties and Safety Net Hospital Profitability: Minimal Impact on These Vulnerable Hospitals.

PubMed

Bazzoli, Gloria J; Thompson, Michael P; Waters, Teresa M

2018-02-08

To examine relationships between penalties assessed by Medicare's Hospital Readmission Reduction Program and Value-Based Purchasing Program and hospital financial condition. Centers for Medicare and Medicaid Services, American Hospital Association, and Area Health Resource File data for 4,824 hospital-year observations. Bivariate and multivariate analysis of pooled cross-sectional data. Safety net hospitals have significantly higher HRRP/VBP penalties, but, unlike nonsafety net hospitals, increases in their penalty rate did not significantly affect their total margins. Safety net hospitals appear to rely on nonpatient care revenues to offset higher penalties for the years studied. While reassuring, these funding streams are volatile and may not be able to compensate for cumulative losses over time. © Health Research and Educational Trust.

Differential Regulation of Angiogenesis using Degradable VEGF-Binding Microspheres

PubMed Central

Belair, David G.; Miller, Michael J.; Wang, Shoujian; Darjatmokon, Soesiawati R.; Binder, Bernard Y.K.; Sheibani, Nader; Murphy, William L.

2016-01-01

Vascular endothelial growth factor (VEGF) spatial and temporal activity must be tightly controlled during angiogenesis to form perfusable vasculature in a healing wound. The native extracellular matrix (ECM) regulates growth factor activity locally via sequestering, and researchers have used ECM-mimicking approaches to regulate the activity of VEGF in cell culture and in vivo. However, the impact of dynamic, affinity-mediated growth factor sequestering has not been explored in detail with biomaterials. Here, we sought to modulate VEGF activity dynamically over time using poly(ethylene glycol) microspheres containing VEGF-binding peptides (VBPs) and exhibiting varying degradation rates. The degradation rate of VBP microspheres conferred a differential ability to up- or down-regulate VEGF activity in culture with primary human endothelial cells. VBP microspheres with fast-degrading crosslinks reduced VEGF activity and signaling, while VBP microspheres with no inherent degradability sequestered and promoted VEGF activity in culture with endothelial cells. VBP microspheres with degradable crosslinks significantly reduced neovascularization in vivo, but neither non-degradable VBP microspheres nor bolus delivery of soluble VBP reduced neovascularization. The covalent incorporation of VBP to degradable microspheres was required to reduce neovascularization in a mouse model of choroidal neovascularization in vivo, which demonstrates a potential clinical application of degradable VBP microspheres to reduce pathological angiogenesis. The results herein highlight the ability to modulate the activity of a sequestered growth factor by changing the crosslinker identity within PEG hydrogel microspheres. The insights gained here may instruct the design and translation of affinity-based growth factor sequestering biomaterials for regenerative medicine applications. PMID:27061268

Affordability Challenges to Value-Based Pricing: Mass Diseases, Orphan Diseases, and Cures.

PubMed

Danzon, Patricia M

2018-03-01

To analyze how value-based pricing (VBP), which grounds the price paid for pharmaceuticals in their value, can manage "affordability" challenges, defined as drugs that meet cost-effectiveness thresholds but are "unaffordable" within the short-run budget. Three specific contexts are examined, drawing on recent experience. First, an effective new treatment for a chronic, progressive disease, such as hepatitis C, creates a budget spike that is transitory because initial prevalence is high, relative to current incidence. Second, "cures" that potentially provide lifetime benefits may claim abnormally high VBP prices, with high immediate budget impact potentially/partially offset by deferred cost savings. Third, although orphan drugs in principle target rare diseases, in aggregate they pose affordability concerns because of the growing number of orphan indications and increasingly high prices. For mass diseases, the transitory budget impact of treating the accumulated patient stock can be managed by stratified rollout that delays treatment of stable patients and prioritizes patients at high risk of deterioration. Delay spreads the budget impact and permits potential savings from launch of competing treatments. For cures, installment payments contingent on outcomes could align payment flows and appropriately shift risk to producers. This approach, however, entails high administrative and incentive costs, especially if applied across multiple payers in the United States. For orphan drugs, the available evidence on research and development trends and returns argues against the need for a higher VBP threshold to incentivize research and development in orphan drugs, given existing statutory benefits under orphan drug legislation. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Does drug price-regulation affect healthcare expenditures?

PubMed

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

2017-09-01

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

[Is the price of cancer drugs related to the cost of develo-pment and production or to the economic value of their clincal efficacy?].

PubMed

Russi, Alberto; Serena, Marta; Palozzo, Angelo C

2016-04-01

In the past years, the expenditure for cancer drugs has quickly increased, especially for biologic agents. Pharmaceutical companies and national health systems have different approaches in handling the issue of drug reimbursement. Companies support a price based on research and development (R&D) expenditures including those for unsuccessful drug projects while national health systems generally argue that pricing should be based on the incremental benefit generated by the agent under examination (value-based pricing - VBP). Nevertheless, current oncologic drugs prices are too high and not really justified by their incremental benefits or innovation, nor can they demonstrate that higher thresholds in QALYs could bring wider societal benefits. In this article we discuss these two points of view in the light of the most recent national and international literature. In Italy, drug reimbursement is currently managed through a mixed approach between the recognition of R&D expenditures and VBP. Reimbursement is also integrated with post-marketing patient-based national registries, particularly in the field of anti-cancer agents, that provide rebates based on financial risk sharing, cost-sharing, payment by results and success fee methods.

Hazard map for volcanic ballistic impacts at Popocatépetl volcano (Mexico)

NASA Astrophysics Data System (ADS)

Alatorre-Ibargüengoitia, Miguel A.; Delgado-Granados, Hugo; Dingwell, Donald B.

2012-11-01

During volcanic explosions, volcanic ballistic projectiles (VBP) are frequently ejected. These projectiles represent a threat to people, infrastructure, vegetation, and aircraft due to their high temperatures and impact velocities. In order to protect people adequately, it is necessary to delimit the projectiles' maximum range within well-defined explosion scenarios likely to occur in a particular volcano. In this study, a general methodology to delimit the hazard zones for VBP during volcanic eruptions is applied to Popocatépetl volcano. Three explosion scenarios with different intensities have been defined based on the past activity of the volcano and parameterized by considering the maximum kinetic energy associated with VBP ejected during previous eruptions. A ballistic model is used to reconstruct the "launching" kinetic energy of VBP observed in the field. In the case of Vulcanian eruptions, the most common type of activity at Popocatépetl, the ballistic model was used in concert with an eruptive model to correlate ballistic range with initial pressure and gas content, parameters that can be estimated by monitoring techniques. The results are validated with field data and video observations of different Vulcanian eruptions at Popocatépetl. For each scenario, the ballistic model is used to calculate the maximum range of VBP under optimum "launching" conditions: ballistic diameter, ejection angle, topography, and wind velocity. Our results are presented in the form of a VBP hazard map with topographic profiles that depict the likely maximum ranges of VBP under explosion scenarios defined specifically for Popocatépetl volcano. The hazard zones shown on the map allow the responsible authorities to plan the definition and mitigation of restricted areas during volcanic crises.

Valuing Trial Designs from a Pharmaceutical Perspective Using Value-Based Pricing.

PubMed

Breeze, Penny; Brennan, Alan

2015-11-01

Our aim was to adapt the traditional framework for expected net benefit of sampling (ENBS) to be more compatible with drug development trials from the pharmaceutical perspective. We modify the traditional framework for conducting ENBS and assume that the price of the drug is conditional on the trial outcomes. We use a value-based pricing (VBP) criterion to determine price conditional on trial data using Bayesian updating of cost-effectiveness (CE) model parameters. We assume that there is a threshold price below which the company would not market the new intervention. We present a case study in which a phase III trial sample size and trial duration are varied. For each trial design, we sampled 10,000 trial outcomes and estimated VBP using a CE model. The expected commercial net benefit is calculated as the expected profits minus the trial costs. A clinical trial with shorter follow-up, and larger sample size, generated the greatest expected commercial net benefit. Increasing the duration of follow-up had a modest impact on profit forecasts. Expected net benefit of sampling can be adapted to value clinical trials in the pharmaceutical industry to optimise the expected commercial net benefit. However, the analyses can be very time consuming for complex CE models. © 2014 The Authors. Health Economics published by John Wiley & Sons Ltd.

VBP15, a novel dissociative steroid compound, reduces NFκB-induced expression of inflammatory cytokines in vitro and symptoms of murine trinitrobenzene sulfonic acid-induced colitis.

PubMed

Damsker, Jesse M; Conklin, Laurie S; Sadri, Soheil; Dillingham, Blythe C; Panchapakesan, Karuna; Heier, Christopher R; McCall, John M; Sandler, Anthony D

2016-09-01

The goal of this study was to assess the capacity of VBP15, a dissociative steroidal compound, to reduce pro-inflammatory cytokine expression in vitro, to reduce symptoms of colitis in the trinitrobenzene sulfonic acid-induced murine model, and to assess the effect of VBP15 on growth stunting in juvenile mice. In vitro studies were performed in primary human intestinal epithelial cells. Colitis was induced in mice by administering trinitrobenzene sulfonic acid. Growth stunting studies were performed in wild type outbred mice. Cells were treated with VBP15 or prednisolone (10 μM) for 24 h. Mice were subjected to 3 days of VBP15 (30 mg/kg) or prednisolone (30 mg/kg) in the colitis study. In the growth stunting study, mice were subjected to VBP15 (10, 30, 45 mg/kg) or prednisolone (10 mg/kg) for 5 weeks. Cytokines were measured by PCR and via Luminex. Colitis symptoms were evaluated by assessing weight loss, intestinal blood, and stool consistency. Growth stunting was assessed using an electronic caliper. VBP15 significantly reduced the in vitro production of CCL5 (p < 0.001) IL-6 (p < 0.001), IL-8 (p < 0.05) and reduced colitis symptoms (p < 0.05). VBP15 caused less growth stunting than prednisolone (p < 0.001) in juvenile mice. VBP15 may reduce symptoms of IBD, while decreasing or avoiding detrimental side effects.

Medicare and Medicaid programs: hospital outpatient prospective payment; ambulatory surgical center payment; hospital value-based purchasing program; physician self-referral; and patient notification requirements in provider agreements. Final rule with comment period.

PubMed

2011-11-30

This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) for CY 2012 to implement applicable statutory requirements and changes arising from our continuing experience with this system. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the OPPS. In addition, this final rule with comment period updates the revised Medicare ambulatory surgical center (ASC) payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system. In this final rule with comment period, we set forth the relative payment weights and payment amounts for services furnished in ASCs, specific HCPCS codes to which these changes apply, and other ratesetting information for the CY 2012 ASC payment system. We are revising the requirements for the Hospital Outpatient Quality Reporting (OQR) Program, adding new requirements for ASC Quality Reporting System, and making additional changes to provisions of the Hospital Inpatient Value-Based Purchasing (VBP) Program. We also are allowing eligible hospitals and CAHs participating in the Medicare Electronic Health Record (EHR) Incentive Program to meet the clinical quality measure reporting requirement of the EHR Incentive Program for payment year 2012 by participating in the 2012 Medicare EHR Incentive Program Electronic Reporting Pilot. Finally, we are making changes to the rules governing the whole hospital and rural provider exceptions to the physician self-referral prohibition for expansion of facility capacity and changes to provider agreement regulations on patient notification requirements.

Societal views on NICE, cancer drugs fund and value-based pricing criteria for prioritising medicines: a cross-sectional survey of 4118 adults in Great Britain.

PubMed

Linley, Warren G; Hughes, Dyfrig A

2013-08-01

The criteria used by the National Institute for Health and Clinical Excellence (NICE) for accepting higher incremental cost-effectiveness ratios for some medicines over others, and the recent introduction of the Cancer Drugs Fund (CDF) in England, are assumed to reflect societal preferences for National Health Service resource allocation. Robust empirical evidence to this effect is lacking. To explore societal preferences for these and other criteria, including those proposed for rewarding new medicines under the future value-based pricing (VBP) system, we conducted a choice-based experiment in 4118 UK adults via web-based surveys. Preferences were determined by asking respondents to allocate fixed funds between different patient and disease types reflecting nine specific prioritisation criteria. Respondents supported the criteria proposed under the VBP system (for severe diseases, address unmet needs, are innovative--provided they offered substantial health benefits, and have wider societal benefits) but did not support the end-of-life premium or the prioritisation of children or disadvantaged populations as specified by NICE, nor the special funding status for treatments of rare diseases, nor the CDF. Policies introduced on the basis of perceived--and not actual--societal values may lead to inappropriate resource allocation decisions with the potential for significant population health and economic consequences. Copyright © 2012 John Wiley & Sons, Ltd.

Forecasting Glacier Evolution and Hindcasting Paleoclimates In Light of Mass Balance Nonlinearities

NASA Astrophysics Data System (ADS)

Malone, A.; Doughty, A. M.; MacAyeal, D. R.

2016-12-01

Glaciers are commonly used barometers of present and past climate change, with their variations often being linked to shifts in the mean climate. Climate variability within a unchanging mean state, however, can produce short term mass balance and glacier length anomalies, complicating this linkage. Also, the mass balance response to this variability can be nonlinear, possibly impacting the longer term state of the glacier. We propose a conceptual model to understand these nonlinearities and quantify their impacts on the longer term mass balance and glacier length. The relationship between mass balance and elevation, i.e. the vertical balance profile (VBP), illuminates these nonlinearities (Figure A). The VBP, given here for a wet tropical glacier, is piecewise, which can lead to different mass balance responses to climate anomalies of similar magnitude but opposite sign. We simulate the mass balance response to climate variability by vertically (temperature anomalies) and horizontally (precipitation anomalies) transposing the VBP for the mean climate (Figure A). The resulting anomalous VBP is the superposition of the two translations. We drive a 1-D flowline model with 10,000 years of anomalous VBPs. The aggregate VBP for the mean climate including variability differs from the VBP for the mean climate excluding variability, having a higher equilibrium line altitude (ELA) and a negative mass balance (Figure B). Accordingly, the glacier retreats, and the equilibrium glacier length for the aggregate VBP is the same as the mean length from the 10,000 year flowline simulation (Figure C). The magnitude of the VBP shift and glacier retreat increases with greater temperature variability and larger discontinuities in the VBP slope. These results highlight the importance of both the climate mean and variability in determining the longer term state of the glacier. Thus, forecasting glacier evolution or hindcasting past climates should also include representation of climate variability.

Uncovering values-based practice: VBP's implicit commitments to subjectivism and relativism.

PubMed

Cassidy, Ben

2013-06-01

Despite assertions to the contrary, KWM Fulford's values-based practice is implicitly committed to subjectivism when it comes to reasoning about values. This renders the approach unworkable. The act of merely uncovering underlying values is not enough to effect change and, therefore, resolve problems if we have no way, even in principle, of determining which values are right and which are wrong. Fulford's only departure from subjectivism about value is his commitment to 'framework values', which seems grounded in a version of ethical relativism. I argue that we need to reject both subjectivism and relativism if progress within ethical discussions about practice is to be meaningful and a real possibility. © 2013 John Wiley & Sons Ltd.

A novel dissociative steroid VBP15 reduces MUC5AC gene expression in airway epithelial cells but lacks the GRE mediated transcriptional properties of dexamethasone.

PubMed

Garvin, Lindsay M; Chen, Yajun; Damsker, Jesse M; Rose, Mary C

2016-06-01

Overproduction of secretory mucins contributes to morbidity/mortality in inflammatory lung diseases. Inflammatory mediators directly increase expression of mucin genes, but few drugs have been shown to directly repress mucin gene expression. IL-1β upregulates the MUC5AC mucin gene in part via the transcription factors NFκB while the glucocorticoid Dexamethasone (Dex) transcriptionally represses MUC5AC expression by Dex-activated GR binding to two GRE cis-sites in the MUC5AC promoter in lung epithelial cells. VBP compounds (ReveraGen BioPharma) maintain anti-inflammatory activity through inhibition of NFκB but exhibit reduced GRE-mediated transcriptional properties associated with adverse side-effects and thus have potential to minimize harmful side effects of long-term steroid therapy in inflammatory lung diseases. We investigated VBP15 efficacy as an anti-mucin agent in two types of airway epithelial cells and analyzed the transcription factor activity and promoter binding associated with VBP15-induced MUC5AC repression. VBP15 reduced MUC5AC mRNA abundance in a dose- and time-dependent manner similar to Dex in the presence or absence of IL-1β in A549 and differentiated human bronchial epithelial cells. Repression was abrogated in the presence of RU486, demonstrating a requirement for GR in the VBP15-induced repression of MUC5AC. Inhibition of NFκB activity resulted in reduced baseline expression of MUC5AC indicating that constitutive activity maintains MUC5AC production. Chromatin immunoprecipitation analysis demonstrated lack of GR and of p65 (NFκB) binding to composite GRE domains in the MUC5AC promoter following VBP15 exposure of cells, in contrast to Dex. These data demonstrate that VBP15 is a novel anti-mucin agent that mediates the reduction of MUC5AC gene expression differently than the classical glucocorticoid, Dex. Copyright © 2016 Elsevier Ltd. All rights reserved.

The VBP and a1/EBP leucine zipper factors bind overlapping subsets of avian retroviral long terminal repeat CCAAT/enhancer elements.

PubMed

Smith, C D; Baglia, L A; Curristin, S M; Ruddell, A

1994-10-01

Two long terminal repeat (LTR) enhancer-binding proteins which may regulate high rates of avian leukosis virus (ALV) LTR-enhanced c-myc transcription during bursal lymphomagenesis have been identified (A. Ruddell, M. Linial, and M. Groudine, Mol. Cell. Biol. 9:5660-5668, 1989). The genes encoding the a1/EBP and a3/EBP binding factors were cloned by expression screening of a lambda gt11 cDNA library from chicken bursal lymphoma cells. The a1/EBP cDNA encodes a novel leucine zipper transcription factor (W. Bowers and A. Ruddell, J. Virol. 66:6578-6586, 1992). The partial a3/EBP cDNA clone encodes amino acids 84 to 313 of vitellogenin gene-binding protein (VBP), a leucine zipper factor that binds the avian vitellogenin II gene promoter (S. Iyer, D. Davis, and J. Burch, Mol. Cell. Biol. 11:4863-4875, 1991). Multiple VBP mRNAs are expressed in B cells in a pattern identical to that previously observed for VBP in other cell types. The LTR-binding activities of VBP, a1/EBP, and B-cell nuclear extract protein were compared and mapped by gel shift, DNase I footprinting, and methylation interference assays. The purified VBP and a1/EBP bacterial fusion proteins bind overlapping but distinct subsets of CCAAT/enhancer elements in the closely related ALV and Rous sarcoma virus (RSV) LTR enhancers. Protein binding to these CCAAT/enhancer elements accounts for most of the labile LTR enhancer-binding activity observed in B-cell nuclear extracts. VBP and a1/EBP could mediate the high rates of ALV and RSV LTR-enhanced transcription in bursal lymphoma cells and many other cell types.

von Hippel–Lindau binding protein 1-mediated degradation of integrase affects HIV-1 gene expression at a postintegration step

PubMed Central

Mousnier, Aurélie; Kubat, Nicole; Massias-Simon, Aurélie; Ségéral, Emmanuel; Rain, Jean-Christophe; Benarous, Richard; Emiliani, Stéphane; Dargemont, Catherine

2007-01-01

HIV-1 integrase, the viral enzyme responsible for provirus integration into the host genome, can be actively degraded by the ubiquitin–proteasome pathway. Here, we identify von Hippel–Lindau binding protein 1(VBP1), a subunit of the prefoldin chaperone, as an integrase cellular binding protein that bridges interaction between integrase and the cullin2 (Cul2)-based von Hippel–Lindau (VHL) ubiquitin ligase. We demonstrate that VBP1 and Cul2/VHL are required for proper HIV-1 expression at a step between integrase-dependent proviral integration into the host genome and transcription of viral genes. Using both an siRNA approach and Cul2/VHL mutant cells, we show that VBP1 and the Cul2/VHL ligase cooperate in the efficient polyubiquitylation of integrase and its subsequent proteasome-mediated degradation. Results presented here support a role for integrase degradation by the prefoldin–VHL–proteasome pathway in the integration–transcription transition of the viral replication cycle. PMID:17698809

A critical narrative analysis of shared decision-making in acute inpatient mental health care.

PubMed

Stacey, Gemma; Felton, Anne; Morgan, Alastair; Stickley, Theo; Willis, Martin; Diamond, Bob; Houghton, Philip; Johnson, Beverley; Dumenya, John

2016-01-01

Shared decision-making (SDM) is a high priority in healthcare policy and is complementary to the recovery philosophy in mental health care. This agenda has been operationalised within the Values-Based Practice (VBP) framework, which offers a theoretical and practical model to promote democratic interprofessional approaches to decision-making. However, these are limited by a lack of recognition of the implications of power implicit within the mental health system. This study considers issues of power within the context of decision-making and examines to what extent decisions about patients' care on acute in-patient wards are perceived to be shared. Focus groups were conducted with 46 mental health professionals, service users, and carers. The data were analysed using the framework of critical narrative analysis (CNA). The findings of the study suggested each group constructed different identity positions, which placed them as inside or outside of the decision-making process. This reflected their view of themselves as best placed to influence a decision on behalf of the service user. In conclusion, the discourse of VBP and SDM needs to take account of how differentials of power and the positioning of speakers affect the context in which decisions take place.

Great Balls of Fire: A probabilistic approach to quantify the hazard related to ballistics - A case study at La Fossa volcano, Vulcano Island, Italy

NASA Astrophysics Data System (ADS)

Biass, Sébastien; Falcone, Jean-Luc; Bonadonna, Costanza; Di Traglia, Federico; Pistolesi, Marco; Rosi, Mauro; Lestuzzi, Pierino

2016-10-01

We present a probabilistic approach to quantify the hazard posed by volcanic ballistic projectiles (VBP) and their potential impact on the built environment. A model named Great Balls of Fire (GBF) is introduced to describe ballistic trajectories of VBPs accounting for a variable drag coefficient and topography. It relies on input parameters easily identifiable in the field and is designed to model large numbers of VBPs stochastically. Associated functions come with the GBF code to post-process model outputs into a comprehensive probabilistic hazard assessment for VBP impacts. Outcomes include probability maps to exceed given thresholds of kinetic energies at impact, hazard curves and probabilistic isoenergy maps. Probabilities are calculated either on equally-sized pixels or zones of interest. The approach is calibrated, validated and applied to La Fossa volcano, Vulcano Island (Italy). We constructed a generic eruption scenario based on stratigraphic studies and numerical inversions of the 1888-1890 long-lasting Vulcanian cycle of La Fossa. Results suggest a ~ 10- 2% probability of occurrence of VBP impacts with kinetic energies ≤ 104 J at the touristic locality of Porto. In parallel, the vulnerability to roof perforation was estimated by combining field observations and published literature, allowing for a first estimate of the potential impact of VBPs during future Vulcanian eruptions. Results indicate a high physical vulnerability to the VBP hazard, and, consequently, half of the building stock having a ≥ 2.5 × 10- 3% probability of roof perforation.

Medicare and Medicaid programs; CY 2015 Home Health Prospective Payment System rate update; Home Health Quality Reporting Requirements; and survey and enforcement requirements for home health agencies. Final rule.

PubMed

2014-11-06

This final rule updates Home Health Prospective Payment System (HH PPS) rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor under the Medicare prospective payment system for home health agencies (HHAs), effective for episodes ending on or after January 1, 2015. As required by the Affordable Care Act, this rule implements the second year of the four-year phase-in of the rebasing adjustments to the HH PPS payment rates. This rule provides information on our efforts to monitor the potential impacts of the rebasing adjustments and the Affordable Care Act mandated face-to-face encounter requirement. This rule also implements: Changes to simplify the face-to-face encounter regulatory requirements; changes to the HH PPS case-mix weights; changes to the home health quality reporting program requirements; changes to simplify the therapy reassessment timeframes; a revision to the Speech-Language Pathology (SLP) personnel qualifications; minor technical regulations text changes; and limitations on the reviewability of the civil monetary penalty provisions. Finally, this rule also discusses Medicare coverage of insulin injections under the HH PPS, the delay in the implementation of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), and a HH value-based purchasing (HH VBP) model.

Possibility of AABW source originating from meddle size polynyas along the coast of Australian-Antarctic Basin

NASA Astrophysics Data System (ADS)

Kitade, Y.; Keishi, S.; Yuki, O.; Aoki, S.; Kobayashi, T.; Suga, T.; Ohshima, K. I.

2016-12-01

Antarctic Bottom Water (AABW) is the densest water in the ocean and globally significant; its production at the Antarctic margin is a key component of the global overturning circulation [eg. Marshall and Speer, 2012]. AABW originating from a middle size polynya called Vincennes Bay Polynya (VBP) was discovered recently [Kitade et al., 2014]. The fact that a middle size polynya can be a formation site of AABW suggests the possibility that the unknown formation area further exists along the coast of Australian-Antarctic Basin. A deep profiling float, called "Deep NINJA" which is able to observe temperature and salinity at depths up to 4,000 m, was developed by Japan Agency for Marine-Earth Science and Technology and Tsurumi-Seiki Co. [Kobayashi et al., 2015]. Five deep floats were deployed along 110oE in Jan. 2014. One of them drifted west almost along the continental rise and has been observing 40 profiles within two years. However, no signal of newly formed AABW has been observed except in the region off VBP, which is consistent with the BROKE results [eg. Bindoff et al., 2000) and our analysis result of BROKE data. Although these observations do not completely negate the additional formation of AABW originating from middle size polynyas located west of VBP, their formation volume of AABW is suggested to be much smaller than that from VBP.

Diagnosis and incidence risk of clinical canine monocytic ehrlichiosis under field conditions in Southern Europe.

PubMed

René-Martellet, Magalie; Lebert, Isabelle; Chêne, Jeanne; Massot, Raphaël; Leon, Marta; Leal, Ana; Badavelli, Stefania; Chalvet-Monfray, Karine; Ducrot, Christian; Abrial, David; Chabanne, Luc; Halos, Lénaïg

2015-01-06

Canine Monocytic Ehrlichiosis (CME), due to the bacterium Ehrlichia canis and transmitted by the brown dog tick Rhipicephalus sanguineus, is a major tick-borne disease in southern Europe. In this area, infections with other vector-borne pathogens (VBP) are also described and result in similar clinical expression. The aim of the present study was to evaluate the incidence risk of clinical CME in those endemic areas and to assess the potential involvement of other VBP in the occurrence of clinical and/or biological signs evocative of the disease. The study was conducted from April to November 2011 in veterinary clinics across Italy, Spain and Portugal. Sick animals were included when fitting at least three clinical and/or biological criteria compatible with ehrlichiosis. Serological tests (SNAP®4Dx, SNAP®Leish tests, Idexx, USA) and diagnostic PCR for E. canis, Anaplasma platys, Anaplasma phagocytophilum, Babesia spp, Hepatozoon canis and Leishmania infantum detection were performed to identify the etiological agents. Ehrlichiosis was considered when three clinical and/or biological suggestive signs were associated with at least one positive paraclinical test (serology or PCR). The annual incidence risk was calculated and data were geo-referenced for map construction. The probabilities of CME and other vector-borne diseases when facing clinical and/or biological signs suggestive of CME were then evaluated. A total of 366 dogs from 78 veterinary clinics were enrolled in the survey. Among them, 99 (27%) were confirmed CME cases, which allowed an estimation of the average annual incidence risk of CME amongst the investigated dog population to be 0.08%. Maps showed an increasing gradient of CME incidence risk from northern towards southern areas, in particular in Italy. It also suggested the existence of hot-spots of infections by VBP in Portugal. In addition, the detection of other VBP in the samples was common and the study demonstrated that a dog with clinical signs evocative of CME is as likely to be positive to Ehrlichia canis as to another VBP. The study confirms the endemicity of CME in southern Europe and highlights the difficulties encountered by veterinarians to differentiate CME from other vector-borne diseases under field conditions.

In situ 3D topographic and shape analysis by synchrotron radiation X-ray microtomography for crystal form identification in polymorphic mixtures

PubMed Central

Yin, Xian-Zhen; Xiao, Ti-Qiao; Nangia, Ashwini; Yang, Shuo; Lu, Xiao-Long; Li, Hai-Yan; Shao, Qun; He, You; York, Peter; Zhang, Ji-Wen

2016-01-01

Polymorphism denotes the existence of more than one crystal structure of a substance, and great practical and theoretical interest for the chemical and pharmaceutical industries. In many cases, it is challenging to produce a pure crystal form and establish a sensitive detection method for the identification of crystal form in a mixture of polymorphs. In this study, an accurate and sensitive method based on synchrotron radiation X-ray computed microtomography (SR-μCT) was devised to identify the polymorphs of clopidogrel bisulphate (CLP). After 3D reconstruction, crystal particles were extracted and dozens of structural parameters were calculated. Whilst, the particle shapes of the two crystal forms were all irregular, the surface of CLP II was found to be rougher than CLP I. In order to classify the crystal form based on the quantitative morphological property of particles, Volume Bias Percentage based on Surface Smoothing (VBP) was defined and a new method based on VBP was successfully developed, with a total matching rate of 99.91% for 4544 particles and a lowest detectable limit of 1%. More important for the mixtures in solid pharmaceutical formulations, the interference of excipients can be avoided, a feature cannot achieved by other available analytical methods. PMID:27097672

76 FR 42169 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment; Ambulatory Surgical...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-18

...This proposed rule would revise the Medicare hospital outpatient prospective payment system (OPPS) to implement applicable statutory requirements and changes arising from our continuing experience with this system. In this proposed rule, we describe the proposed changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the OPPS. These proposed changes would be applicable to services furnished on or after January 1, 2012. In addition, this proposed rule would update the revised Medicare ambulatory surgical center (ASC) payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system. In this proposed rule, we set forth the proposed relative payment weights and payment amounts for services furnished in ASCs, specific HCPCS codes to which these proposed changes would apply, and other proposed ratesetting information for the CY 2012 ASC payment system. These proposed changes would be applicable to services furnished on or after January 1, 2012. We are proposing to revise the requirements for the Hospital Outpatient Quality Reporting (IQR) Program, add new requirements for ASC Quality Reporting System, and make additional changes to provisions of the Hospital Inpatient Value-Based Purchasing (VBP) Program. We also are proposing to allow eligible hospitals and CAHs participating in the Medicare Electronic Health Record (EHR) Incentive Program to meet the clinical quality measure reporting requirement of the EHR Incentive Program for payment year 2012 by participating in the 2012 Medicare EHR Incentive Program Electronic Reporting Pilot. In addition, we are proposing to make changes to the rules governing the whole hospital and rural provider exceptions to the physician self-referral prohibition for expansion of facility capacity and changes to provider agreement regulations on patient notification requirements.

OFT, VBP: QED?

PubMed

Claxton, Karl

2007-06-01

The report by the Office of Fair Trading (OFT) on the UK pharmaceutical price regulation scheme (PPRS) recommends the reform of the current scheme, which is a combination of profit and price controls, to one where price is based on the health benefits offered by a pharmaceutical. On closer examination some of the more commonly expressed concerns about these proposals do not seem to be well founded. In principle, the OFT's recommendations may contribute to allocative and dynamic efficiency in the NHS. However, there are some dangers and the details of how it will be implemented are crucial. For example, value-based pricing with an inappropriate threshold for cost-effectiveness, or an inappropriate pricing structure, could lead to technologies being adopted at prices where their benefits, in terms of health outcome, do not offset the health displaced elsewhere in the NHS, a situation in which the NHS is damaged rather than improved by innovation. A failure to account for uncertainty and the value of evidence in negotiating prices and coverage could also undermine the evidence base for future NHS practice. Whatever view is taken, the OFT report will inevitably shape the scope of future policy debates about value, guidance, price and innovation.

Reducing uncertainty in value-based pricing using evidence development agreements: the case of continuous intraduodenal infusion of levodopa/carbidopa (Duodopa®) in Sweden.

PubMed

Willis, Michael; Persson, Ulf; Zoellner, York; Gradl, Birgit

2010-01-01

Value-based pricing (VBP), whereby prices are set according to the perceived benefits offered to the consumer at a time when costs and benefits are characterized by considerable uncertainty and are then reviewed ex post, is a much discussed topic in pharmaceutical reimbursement. It is usually combined with coverage with evidence development (CED), a tool in which manufacturers are granted temporary reimbursement but are required to collect and submit additional health economic data at review. Many countries, including the UK, are signalling shifts in this direction. Several countries, including Sweden, have already adopted this approach and offer good insight into the benefits and pitfalls in actual practice. To describe VBP reimbursement decision making using CED in actual practice in Sweden. Decision making by The Dental and Pharmaceutical Benefits Agency (TLV) in Sweden was reviewed using a case study of continuous intraduodenal infusion of levodopa/carbidopa (Duodopa®) in the treatment of advanced Parkinson's disease (PD) with severe motor fluctuations. The manufacturer of Duodopa® applied for reimbursement in late 2003. While the proper economic data were not included in the submission, TLV granted reimbursement until early 2005 to provide time for the manufacturer to submit a formal economic evaluation. The re-submission with economic data was considered inadequate to judge cost effectiveness, so TLV granted an additional extension of reimbursement until August 2007, at which time conclusive data were expected. The manufacturer initiated a 3-year, prospective health economic study and a formal economic model. Data from a pre-planned interim analysis of the data were loaded into the model and the cost-effectiveness ratio was the basis of the next re-submission. TLV concluded that the data were suitable for making a definite decision and that the drug was not cost effective, deciding to discontinue reimbursement for any new patients (current patients were unaffected). The manufacturer continued to collect data and to improve the economic model and re-submitted in 2008. New data and the improved model resulted in reduced uncertainty and a lower cost-effectiveness ratio in the range of Swedish kronor (SEK)430,000 per QALY gained in the base-case analysis, ranging up to SEK900,000 in the most conservative sensitivity analysis, resulting in reimbursement being granted. The case of Duodopa® provides excellent insight into VBP reimbursement decision making in combination with CED and ex post review in actual practice. Publicly available decisions document the rigorous, time-consuming process (four iterations were required before a final decision could be reached). The data generated as part of the risk-sharing agreement proved correct the initial decision to grant limited coverage despite lack of economic data. Access was provided to 100 patients while evidence was generated. Economic appraisal differs from clinical assessment, and decision makers benefit from analysis of naturalistic, actual practice data. Despite reviewing the initial trial-based, 'piggy-back' economic analysis, TLV was uncertain of the cost effectiveness in actual practice and deferred a final decision until observational data from the DAPHNE study became available. Second, acceptance of economic modelling and use of temporary reimbursement conditional on additional evidence development provide a mechanism for risk sharing between TLV and manufacturers, which enabled patient access to a drug with proven clinical benefit while necessary evidence to support claims of cost effectiveness could be generated.

What can the past of pay-for-performance tell us about the future of Value-Based Purchasing in Medicare?

PubMed

Ryan, Andrew M; Damberg, Cheryl L

2013-06-01

The Medicare program has implemented pay-for-performance (P4P), or Value-Based Purchasing, for inpatient care and for Medicare Advantage plans, and plans to implement a program for physicians in 2015. In this paper, we review evidence on the effectiveness of P4P and identify design criteria deemed to be best practice in P4P. We then assess the extent to which Medicare's existing and planned Value-Based Purchasing programs align with these best practices. Of the seven identified best practices in P4P program design, the Hospital Value-Based Purchasing program is strongly aligned with two of the best practices, moderately aligned with three, weakly aligned with one, and has unclear alignment with one best practice. The Physician Value-Based Purchasing Modifier is strongly aligned with two of the best practices, moderately aligned with one, weakly aligned with three, and has unclear alignment with one of the best practices. The Medicare Advantage Quality Bonus Program is strongly aligned with four of the best practices, moderately aligned with two, and weakly aligned with one of the best practices. We identify enduring gaps in P4P literature as it relates to Medicare's plans for Value-Based Purchasing and discuss important issues in the future of these implementations in Medicare. Copyright © 2013 Elsevier Inc. All rights reserved.

42 CFR § 484.330 - Process for determining and applying the value-based payment adjustment under the Home Health...

Code of Federal Regulations, 2010 CFR

2016-10-01

...-based payment adjustment under the Home Health Value-Based Purchasing (HHVBP) Model. § 484.330 Section... (HHVBP) Model Components for Competing Home Health Agencies Within State Boundaries § 484.330 Process for determining and applying the value-based payment adjustment under the Home Health Value-Based Purchasing...

42 CFR § 484.330 - Process for determining and applying the value-based payment adjustment under the Home Health...

Code of Federal Regulations, 2010 CFR

2017-10-01

...-based payment adjustment under the Home Health Value-Based Purchasing (HHVBP) Model. § 484.330 Section... (HHVBP) Model Components for Competing Home Health Agencies Within State Boundaries § 484.330 Process for determining and applying the value-based payment adjustment under the Home Health Value-Based Purchasing...

Molecular detection of vector-borne pathogens in blood and splenic samples from dogs with splenic disease.

PubMed

Movilla, Rebeca; Altet, Laura; Serrano, Lorena; Tabar, María-Dolores; Roura, Xavier

2017-03-13

The spleen is a highly perfused organ involved in the immunological control and elimination of vector-borne pathogens (VBP), which could have a fundamental role in the pathogenesis of splenic disease. This study aimed to evaluate certain VBP in samples from dogs with splenic lesions. Seventy-seven EDTA-blood and 64 splenic tissue samples were collected from 78 dogs with splenic disease in a Mediterranean area. Babesia spp., Bartonella spp., Ehrlichia/Anaplasma spp., Hepatozoon canis, Leishmania infantum, hemotropic Mycoplasma spp. and Rickettsia spp. were targeted using PCR assays. Sixty EDTA-blood samples from dogs without evidence of splenic lesions were included as a control group. More than half (51.56%) of the biopsies (33/64) were consistent with benign lesions and 48.43% (31/64) with malignancy, mostly hemangiosarcoma (25/31). PCR yielded positive results in 13 dogs with spleen alterations (16.67%), for Babesia canis (n = 3), Babesia gibsoni (n = 2), hemotropic Mycoplasma spp. (n = 2), Rickettsia massiliae (n = 1) and "Babesia vulpes" (n = 1), in blood; and for B. canis, B. gibsoni, Ehrlichia canis and L. infantum (n = 1 each), in spleen. Two control dogs (3.3%) were positive for B. gibsoni and H. canis (n = 1 each). Benign lesions were detected in the 61.54% of infected dogs (8/13); the remaining 38.46% were diagnosed with malignancies (5/13). Infection was significantly associated to the presence of splenic disease (P = 0.013). There was no difference in the prevalence of infection between dogs with benign and malignant splenic lesions (P = 0.69); however B. canis was more prevalent in dogs with hemangiosarcoma (P = 0.006). VBP infection could be involved in the pathogenesis of splenic disease. The immunological role of the spleen could predispose to alterations of this organ in infected dogs. Interestingly, all dogs with B. canis infection were diagnosed with hemangiosarcoma in the present survey. As previously reported, results support that VBP diagnosis could be improved by analysis of samples from different tissues. The sample size included here warrants further investigation.

Marketing depression care management to employers: design of a randomized controlled trial.

PubMed

Rost, Kathryn M; Marshall, Donna

2010-03-16

Randomized trials demonstrate that depression care management can improve clinical and work outcomes sufficiently for selected employers to realize a return on investment. Employers can now purchase depression products that provide depression care management, defined as employee screening, education, monitoring, and clinician feedback for all depressed employees. We developed an intervention to encourage employers to purchase a depression product that offers the type, intensity, and duration of care management shown to improve clinical and work outcomes. In a randomized controlled trial conducted with 360 employers of 30 regional business coalitions, the research team proposes to compare the impact of a value-based marketing intervention to usual-care marketing on employer purchase of depression products. The study will also identify mediators and organizational-level moderators of intervention impact. Employers randomized to the value-based condition receive a presentation encouraging them to purchase depression products scientifically shown to benefit the employee and the employer. Employers randomized to the usual-care condition receive a presentation encouraging them to monitor and improve quality indicators for outpatient depression treatment. Because previous research demonstrates that the usual-care intervention will have little to no impact on employer purchasing, depression product purchasing rates in the usual-care condition capture vendor efforts to market depression products to employers in both conditions while the value-based intervention is being conducted. Employers in both conditions are also provided free technical assistance to undertake the actions each presentation encourages. The research team will use intent-to-treat models of all available data to evaluate intervention impact on the purchase of depression products using a cumulative incidence analysis of 12- and 24-month data. By addressing the 'value to whom?' question, the study advances knowledge about one of the most pivotal problems in the translation of evidence-based care to 'real world' settings: whether purchasers can be influenced to buy healthcare products on the basis of value and not exclusively on the basis of cost. If value-based marketing increases depression product purchase rates over usual care, this study will provide encouragement to market new healthcare products on the basis of the product's value to the purchaser as well as the recipient of care. NCT01013220.

Marketing depression care management to employers: design of a randomized controlled trial

PubMed Central

2010-01-01

Background Randomized trials demonstrate that depression care management can improve clinical and work outcomes sufficiently for selected employers to realize a return on investment. Employers can now purchase depression products that provide depression care management, defined as employee screening, education, monitoring, and clinician feedback for all depressed employees. We developed an intervention to encourage employers to purchase a depression product that offers the type, intensity, and duration of care management shown to improve clinical and work outcomes. Methods In a randomized controlled trial conducted with 360 employers of 30 regional business coalitions, the research team proposes to compare the impact of a value-based marketing intervention to usual-care marketing on employer purchase of depression products. The study will also identify mediators and organizational-level moderators of intervention impact. Employers randomized to the value-based condition receive a presentation encouraging them to purchase depression products scientifically shown to benefit the employee and the employer. Employers randomized to the usual-care condition receive a presentation encouraging them to monitor and improve quality indicators for outpatient depression treatment. Because previous research demonstrates that the usual-care intervention will have little to no impact on employer purchasing, depression product purchasing rates in the usual-care condition capture vendor efforts to market depression products to employers in both conditions while the value-based intervention is being conducted. Employers in both conditions are also provided free technical assistance to undertake the actions each presentation encourages. The research team will use intent-to-treat models of all available data to evaluate intervention impact on the purchase of depression products using a cumulative incidence analysis of 12- and 24-month data. Discussion By addressing the 'value to whom?' question, the study advances knowledge about one of the most pivotal problems in the translation of evidence-based care to 'real world' settings: whether purchasers can be influenced to buy healthcare products on the basis of value and not exclusively on the basis of cost. If value-based marketing increases depression product purchase rates over usual care, this study will provide encouragement to market new healthcare products on the basis of the product's value to the purchaser as well as the recipient of care. Trial Registration Clinical Trials Registration Number: NCT01013220 PMID:20233448

The HackensackUMC Value-Based Care Model: Building Essentials for Value-Based Purchasing.

PubMed

Douglas, Claudia; Aroh, Dianne; Colella, Joan; Quadri, Mohammed

2016-01-01

The Affordable Care Act, 2010, and the subsequent shift from a quantity-focus to a value-centric reimbursement model led our organization to create the HackensackUMC Value-Based Care Model to improve our process capability and performance to meet and sustain the triple aims of value-based purchasing: higher quality, lower cost, and consumer perception. This article describes the basics of our model and illustrates how we used it to reduce the costs of our patient sitter program.

Incentive Program Requirements for Eligible Hospitals, Critical Access Hospitals, and Eligible Professionals; Provider-Based Status of Indian Health Service and Tribal Facilities and Organizations; Costs Reporting and Provider Requirements; Agreement Termination Notices. Final rule.

PubMed

2017-08-14

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2018. Some of these changes implement certain statutory provisions contained in the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Medicare Access and CHIP Reauthorization Act of 2015, the 21st Century Cures Act, and other legislation. We also are making changes relating to the provider-based status of Indian Health Service (IHS) and Tribal facilities and organizations and to the low-volume hospital payment adjustment for hospitals operated by the IHS or a Tribe. In addition, we are providing the market basket update that will apply to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2018. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2018. In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific Medicare providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities). We also are establishing new requirements or revising existing requirements for eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) participating in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. We are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program. We also are making changes relating to transparency of accrediting organization survey reports and plans of correction of providers and suppliers; electronic signature and electronic submission of the Certification and Settlement Summary page of the Medicare cost reports; and clarification of provider disposal of assets.

Value-based formulas for purchasing. PEHP's designated service provider program: value-based purchasing through global fees.

PubMed

Emery, D W

1997-01-01

In many circles, managed care and capitation have become synonymous; unfortunately, the assumptions informing capitation are based on a flawed unidimensional model of risk. PEHP of Utah has rejected the unidimensional model and has therefore embraced a multidimensional model of risk that suggests that global fees are the optimal purchasing modality. A globally priced episode of care forms a natural unit of analysis that enhances purchasing clarity, allows providers to more efficiently focus on the Marginal Rate of Technical Substitution, and conforms to the multidimensional reality of risk. Most importantly, global fees simultaneously maximize patient choice and provider cost consciousness.

Moving healthcare quality forward with nursing-sensitive value-based purchasing.

PubMed

Kavanagh, Kevin T; Cimiotti, Jeannie P; Abusalem, Said; Coty, Mary-Beth

2012-12-01

To underscore the need for health system reform and emphasize nursing measures as a key component in our healthcare reimbursement system. Nursing-sensitive value-based purchasing (NSVBP) has been proposed as an initiative that would help to promote optimal staffing and practice environment through financial rewards and transparency of structure, process, and patient outcome measures. This article reviews the medical, governmental, institutional, and lay literature regarding the necessity for, method of implementation of, and potential impact of NSVBP. Research has shown that adverse events and mortality are highly dependent on nurse staffing levels and skill mix. The National Database of Nursing Quality Indicators (NDNQI), along with other well-developed indicators, can be used as nursing-sensitive measurements for value-based purchasing initiatives. Nursing-sensitive measures are an important component of value-based purchasing. Value-based purchasing is in its infancy. Devising an effective system that recognizes and incorporates nursing measures will facilitate the success of this initiative. NSVBP needs to be designed and incentivized to decrease adverse events, hospital stays, and readmission rates, thereby decreasing societal healthcare costs. NSVBP has the potential for improving the quality of nursing care by financially motivating hospitals to have an optimal nurse practice environment capable of producing optimal patient outcomes by aligning cost effectiveness for hospitals to that of the patient and society. © 2012 Sigma Theta Tau International.

Moving Healthcare Quality Forward With Nursing-Sensitive Value-Based Purchasing

PubMed Central

Kavanagh, Kevin T; Cimiotti, Jeannie P; Abusalem, Said; Coty, Mary-Beth

2012-01-01

Purpose: To underscore the need for health system reform and emphasize nursing measures as a key component in our healthcare reimbursement system. Design and Methods: Nursing-sensitive value-based purchasing (NSVBP) has been proposed as an initiative that would help to promote optimal staffing and practice environment through financial rewards and transparency of structure, process, and patient outcome measures. This article reviews the medical, governmental, institutional, and lay literature regarding the necessity for, method of implementation of, and potential impact of NSVBP. Findings: Research has shown that adverse events and mortality are highly dependent on nurse staffing levels and skill mix. The National Database of Nursing Quality Indicators (NDNQI), along with other well-developed indicators, can be used as nursing-sensitive measurements for value-based purchasing initiatives. Nursing-sensitive measures are an important component of value-based purchasing. Conclusions: Value-based purchasing is in its infancy. Devising an effective system that recognizes and incorporates nursing measures will facilitate the success of this initiative. NSVBP needs to be designed and incentivized to decrease adverse events, hospital stays, and readmission rates, thereby decreasing societal healthcare costs. Clinical Relevance: NSVBP has the potential for improving the quality of nursing care by financially motivating hospitals to have an optimal nurse practice environment capable of producing optimal patient outcomes by aligning cost effectiveness for hospitals to that of the patient and society. PMID:23066956

Physician-owned Surgical Hospitals Outperform Other Hospitals in the Medicare Value-based Purchasing Program

PubMed Central

Ramirez, Adriana G; Tracci, Margaret C; Stukenborg, George J; Turrentine, Florence E; Kozower, Benjamin D; Jones, R Scott

2016-01-01

Background The Hospital Value-Based Purchasing Program measures value of care provided by participating Medicare hospitals while creating financial incentives for quality improvement and fostering increased transparency. Limited information is available comparing hospital performance across healthcare business models. Study Design 2015 hospital Value-Based Purchasing Program results were used to examine hospital performance by business model. General linear modeling assessed differences in mean total performance score, hospital case mix index, and differences after adjustment for differences in hospital case mix index. Results Of 3089 hospitals with Total Performance Scores (TPS), categories of representative healthcare business models included 104 Physician-owned Surgical Hospitals (POSH), 111 University HealthSystem Consortium (UHC), 14 US News & World Report Honor Roll (USNWR) Hospitals, 33 Kaiser Permanente, and 124 Pioneer Accountable Care Organization affiliated hospitals. Estimated mean TPS for POSH (64.4, 95% CI 61.83, 66.38) and Kaiser (60.79, 95% CI 56.56, 65.03) were significantly higher compared to all remaining hospitals while UHC members (36.8, 95% CI 34.51, 39.17) performed below the mean (p < 0.0001). Significant differences in mean hospital case mix index included POSH (mean 2.32, p<0.0001), USNWR honorees (mean 2.24, p 0.0140) and UHC members (mean =1.99, p<0.0001) while Kaiser Permanente hospitals had lower case mix value (mean =1.54, p<0.0001). Re-estimation of TPS did not change the original results after adjustment for differences in hospital case mix index. Conclusions The Hospital Value-Based Purchasing Program revealed superior hospital performance associated with business model. Closer inspection of high-value hospitals may guide value improvement and policy-making decisions for all Medicare Value-Based Purchasing Program Hospitals. PMID:27502368

Employers' use of value-based purchasing strategies.

PubMed

Rosenthal, Meredith B; Landon, Bruce E; Normand, Sharon-Lise T; Frank, Richard G; Ahmad, Thaniyyah S; Epstein, Arnold M

2007-11-21

Value-based purchasing by employers has often been portrayed as the lynchpin to quality improvement in a market-based health care system. Although a small group of the largest national employers has been actively engaged in promoting quality measurement, reporting, and pay for performance, it is unknown whether these ideas have significantly permeated employer-sponsored health benefit purchasing. To provide systematic descriptions and analyses of value-based purchasing and related efforts to improve quality of care by health care purchasers. We conducted telephone interviews with executives at 609 of the largest employers across 41 US markets between July 2005 and March 2006. The 41 randomly selected markets have at least 100,000 persons enrolled in health maintenance organizations, include approximately 91% of individuals enrolled in health maintenance organizations nationally, and represent roughly 78% of the US metropolitan population. Using the Dun & Bradstreet database of US employers, we identified the 26 largest firms in each market. Firms ranged in size from 60 to 250,000 employees. The degree to which value-based purchasing and related strategies are reported being used by employers. Percentages were weighted by number of employees. Of 1041 companies contacted, 609 employer representatives completed the survey (response rate, 64%). A large percentage of surveyed executives reported that they examine health plan quality data (269 respondents; 65% [95% confidence interval {CI}, 57%-74%]; P<.001), but few reported using it for performance rewards (49 respondents; 17% [95% CI, 7%-27%]; P=.008) or to influence employees (71 respondents; 23% [95% CI, 13%-33%]). Physician quality information is even less commonly examined (71 respondents; 16% [95% CI, 9%-23%]) or used by employers to reward performance (8 respondents; 2% [95% CI, 0%-3%]) or influence employee choice of providers (34 respondents; 8% [95% CI, 3%-12%]). Surveyed employers as a whole do not appear to be individually implementing incentives and programs in line with value-based purchasing ideals.

Association between canine leishmaniosis and Ehrlichia canis co-infection: a prospective case-control study.

PubMed

Attipa, Charalampos; Solano-Gallego, Laia; Papasouliotis, Kostas; Soutter, Francesca; Morris, David; Helps, Chris; Carver, Scott; Tasker, Séverine

2018-03-20

In the Mediterranean basin, Leishmania infantum is a major cause of disease in dogs, which are frequently co-infected with other vector-borne pathogens (VBP). However, the associations between dogs with clinical leishmaniosis (ClinL) and VBP co-infections have not been studied. We assessed the risk of VBP infections in dogs with ClinL and healthy controls. We conducted a prospective case-control study of dogs with ClinL (positive qPCR and ELISA antibody for L. infantum on peripheral blood) and clinically healthy, ideally breed-, sex- and age-matched, control dogs (negative qPCR and ELISA antibody for L. infantum on peripheral blood) from Paphos, Cyprus. We obtained demographic data and all dogs underwent PCR on EDTA-blood extracted DNA for haemoplasma species, Ehrlichia/Anaplasma spp., Babesia spp., and Hepatozoon spp., with DNA sequencing to identify infecting species. We used logistic regression analysis and structural equation modelling (SEM) to evaluate the risk of VBP infections between ClinL cases and controls. From the 50 enrolled dogs with ClinL, DNA was detected in 24 (48%) for Hepatozoon spp., 14 (28%) for Mycoplasma haemocanis, 6 (12%) for Ehrlichia canis and 2 (4%) for Anaplasma platys. In the 92 enrolled control dogs, DNA was detected in 41 (45%) for Hepatozoon spp., 18 (20%) for M. haemocanis, 1 (1%) for E. canis and 3 (3%) for A. platys. No Babesia spp. or "Candidatus Mycoplasma haematoparvum" DNA was detected in any dog. No statistical differences were found between the ClinL and controls regarding age, sex, breed, lifestyle and use of ectoparasitic prevention. A significant association between ClinL and E. canis infection (OR = 12.4, 95% CI: 1.5-106.0, P = 0.022) was found compared to controls by multivariate logistic regression. This association was confirmed using SEM, which further identified that younger dogs were more likely to be infected with each of Hepatozoon spp. and M. haemocanis, and dogs with Hepatozoon spp. were more likely to be co-infected with M. haemocanis. Dogs with ClinL are at a higher risk of co-infection with E. canis than clinically healthy dogs. We recommend that dogs diagnosed with ClinL should be tested for E. canis co-infection using PCR.

Physician-Owned Surgical Hospitals Outperform Other Hospitals in Medicare Value-Based Purchasing Program.

PubMed

Ramirez, Adriana G; Tracci, Margaret C; Stukenborg, George J; Turrentine, Florence E; Kozower, Benjamin D; Jones, R Scott

2016-10-01

The Hospital Value-Based Purchasing Program measures value of care provided by participating Medicare hospitals and creates financial incentives for quality improvement and fosters increased transparency. Limited information is available comparing hospital performance across health care business models. The 2015 Hospital Value-Based Purchasing Program results were used to examine hospital performance by business model. General linear modeling assessed differences in mean total performance score, hospital case mix index, and differences after adjustment for differences in hospital case mix index. Of 3,089 hospitals with total performance scores, categories of representative health care business models included 104 physician-owned surgical hospitals, 111 University HealthSystem Consortium, 14 US News & World Report Honor Roll hospitals, 33 Kaiser Permanente, and 124 Pioneer accountable care organization affiliated hospitals. Estimated mean total performance scores for physician-owned surgical hospitals (64.4; 95% CI, 61.83-66.38) and Kaiser Permanente (60.79; 95% CI, 56.56-65.03) were significantly higher compared with all remaining hospitals, and University HealthSystem Consortium members (36.8; 95% CI, 34.51-39.17) performed below the mean (p < 0.0001). Significant differences in mean hospital case mix index included physician-owned surgical hospitals (mean 2.32; p < 0.0001), US News & World Report honorees (mean 2.24; p = 0.0140), and University HealthSystem Consortium members (mean 1.99; p < 0.0001), and Kaiser Permanente hospitals had lower case mix value (mean 1.54; p < 0.0001). Re-estimation of total performance scores did not change the original results after adjustment for differences in hospital case mix index. The Hospital Value-Based Purchasing Program revealed superior hospital performance associated with business model. Closer inspection of high-value hospitals can guide value improvement and policy-making decisions for all Medicare Value-Based Purchasing Program Hospitals. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Value-based purchasing and hospital acquired conditions: are we seeing improvement?

PubMed

Spaulding, Aaron; Zhao, Mei; Haley, D Rob

2014-12-01

To determine if the Value-Based Purchasing Performance Scoring system correlates with hospital acquired condition quality indicators. This study utilizes the following secondary data sources: the American Hospital Association (AHA) annual survey and the Centers for Medicare and Medicaid (CMS) Value-Based Purchasing and Hospital Acquired Conditions databases. Zero-inflated negative binomial regression was used to examine the effect of CMS total performance score on counts of hospital acquired conditions. Hospital structure variables including size, ownership, teaching status, payer mix, case mix, and location were utilized as control variables. The secondary data sources were merged into a single database using Stata 10. Total performance scores, which are used to determine if hospitals should receive incentive money, do not correlate well with quality outcome in the form of hospital acquired conditions. Value-based purchasing does not appear to correlate with improved quality and patient safety as indicated by Hospital Acquired Condition (HAC) scores. This leads us to believe that either the total performance score does not measure what it should, or the quality outcome measurements do not reflect the quality of the total performance scores measure. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Introducing Value-Based Purchasing into TRICARE Reform

PubMed Central

Hosek, Susan D.; Sorbero, Melony E.; Martsolf, Grant; Kandrack, Ryan

2017-01-01

Abstract TRICARE, the health benefits program created for beneficiaries of the U.S. Department of Defense, covers health care provided in military treatment facilities and by civilian providers. Congress is now considering how to update TRICARE, which was first developed in the 1980s drawing on managed care concepts from civilian health plans. This article places TRICARE's current managed care strategy in historical context and describes recent innovations by private insurers and Medicare intended to enhance the value---cost and quality---of the care they purchase for their members. With this movement toward value-based purchasing as background, the authors evaluate two existing proposals for reform and describe an alternative approach that blends the existing proposals. PMID:28845347

Magnetic phase boundaries of CsMnF3: XY-to-Ising crossover and the virtual bicritical point

NASA Astrophysics Data System (ADS)

Shapira, Y.; Oliveira, N. F., Jr.; Chang, T. S.

1980-02-01

The ordering temperature Tc of the easy-plane hexagonal antiferromagnet CsMnF3 was measured as a function of magnetic field H, up to 120 kOe. Tc was determined from the thermal expansion anomaly at constant H. At H=0, TN≡Tc(0)=51.4 K. When H--> is in the hexagonal plane, the boundary Tc(H) is bow shaped: with increasing H, Tc first increases, then passes through a maximum, and later decreases. The maximum Tc is ~37 mK above TN, and it occurs at H≅29.5 kOe. The bow-shaped phase boundary is attributed to the XY-to-Ising crossover which is induced by the magnetic field, as discussed by Fisher, Nelson, and Kosterlitz. Fits to the phase boundary Tc(H) give a crossover exponent φ=1.185+/-0.03 for one sample and φ=1.184+/-0.025 for another, compared to the theoretical value φ(n=2)=1.175+/-0.015. When H--> is perpendicular to the hexagonal plane, Tc decreases monotonically with increasing H, but the decrease is not in accordance with mean-field theory, which predicts a decrease proportional to H2. The deviation from mean-field behavior is attributed to a virtual bicritical point (VBP) with Heisenberg symmetry, which exists mathematically at a negative value of H2. Although the VBP cannot be observed directly, it affects the behavior in the observable region of H2>=0. Physically, a magnetic field applied perpendicular to the easy plane enhances the Heisenberg-to-XY symmetry breaking, which at H=0 is solely due to the weak easy-plane uniaxial anisotropy. The enhanced symmetry breaking causes a non-mean-field dependence of Tc on H. An equation derived on this basis gives a good description of the phase boundary Tc(H). This equation contains three adjustable parameters, two of which can also be estimated without recourse to the phase boundary Tc(H). The values for these two parameters obtained from a best fit to Tc(H) agree with the independent estimates.

Why do consumers respond to eco-labels? The case of Korea.

PubMed

Hwang, Jung-Ah; Park, Youkyoung; Kim, Yeonbae

2016-01-01

Although eco-labels were introduced with the intention of encouraging eco-friendly purchasing behavior by consumers, they have had little effect on consumers' purchasing decisions, and therefore a significant gap exists between eco-label awareness and actual purchasing behavior. The aim of this study was to analyze consumer preference, in terms of public and private values, for two types of Korean eco-label that have been administered by the Korean government since 1992. Analyses were based on a structural equation model, employing the theory of reasoned action. Data were collected by survey. The results indicate that although general consumers are highly aware of the publicly valuable information that eco-labels provide, privately valuable information exerts far greater power over their purchasing intentions. Therefore, a supplementary policy that converts public value to private value could promote the purchase of eco-labeled products.

The current state of nursing performance measurement, public reporting, and value-based purchasing.

PubMed

Kurtzman, Ellen T; Dawson, Ellen M; Johnson, Jean E

2008-08-01

Over the last decade, there has been a substantial investment in holding health care providers accountable for the quality of care provided in hospitals and other settings of care. This investment has been realized through the proliferation of national policies that address performance measurement, public reporting, and value-based purchasing. Although nurses represent the largest segment of the health care workforce and despite their acknowledged role in patient safety and health care outcomes, they have been largely absent from policy setting in these areas. This article provides an analysis of current nursing performance measurement and public reporting initiatives and presents a summary of emerging trends in value-based purchasing, with an emphasis on activities in the United States. The article synthesizes issues of relevance to advancing the current climate for nursing quality and concludes with key issues for future policy setting.

Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and fiscal year 2013 rates; hospitals' resident caps for graduate medical education payment purposes; quality reporting requirements for specific providers and for ambulatory surgical centers. final rule.

PubMed

2012-08-31

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of the changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation. These changes will be applicable to discharges occurring on or after October 1, 2012, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits will be effective for cost reporting periods beginning on or after October 1, 2012. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes made by the Affordable Care Act. Generally, these changes will be applicable to discharges occurring on or after October 1, 2012, unless otherwise specified in this final rule. In addition, we are implementing changes relating to determining a hospital's full-time equivalent (FTE) resident cap for the purpose of graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or revised requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are participating in Medicare. We also are establishing new administrative, data completeness, and extraordinary circumstance waivers or extension requests requirements, as well as a reconsideration process, for quality reporting by ambulatory surgical centers (ASCs) that are participating in Medicare. We are establishing requirements for the Hospital Value-Based Purchasing (VBP) Program and the Hospital Readmissions Reduction Program.

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

PubMed

Jasuta, Lynette

2016-06-01

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

Executive summary: value-based purchasing and technology assessment in orthopaedics.

PubMed

Ranawat, Anil S; Nunley, Ryan; Bozic, Kevin

2009-10-01

As US healthcare expenditures continue to rise, reform has shifted from spending controls to value-based purchasing. This paradigm shift is a drastic change on how health care is delivered and reimbursed. For the shift to work, policymakers and physicians must restructure the present system by using initiatives such as process reengineering, insurance and payment reforms, physician reeducation, data and quality measurements, and technology assessments. Value, as defined in economic terms, will be a critical concept in modern healthcare reform. We summarize the conclusions of this ABJS Carl T. Brighton Workshop on healthcare reform.

Factors affecting the valuation of physician practices.

PubMed

Cleverley, W O

1997-12-01

Valuation of physician practices provides physicians with a benchmark of their business success and helps purchasers negotiate a purchase price. The Center for Healthcare Industry Performance Studies (CHIPS) recently conducted a survey of physician practice acquisitions. The survey collected data on salaries and benefits paid to physicians after practice acquisition, historical profitability of the acquired practice, and specific values assigned to both tangible and intangible assets in the practice. Some of the survey's critical conclusions include: hospitals tend to acquire unprofitable practices, value is based on historical revenues rather than historical profits, the importance of valuation methodology and payer mix is underestimated, tangible assets represent a large part of the purchase price, and hospitals tend to pay higher physician compensation than do other purchasers.

[The price-based certainty of purchase influences consumer behavior for discount].

PubMed

Arihara, Katsuhiko; Ariga, Atsunori; Furuya, Takeshi

2016-04-01

Tversky & Kahneman (1981) reported that most participants decided to drive when they could save money on a low-price good as compared to when they could save on a high-price good, even though the discount prices were same. Although this irrational decision making has been interpreted as a rate-dependent estimation of value (prospect theory), this study newly proposes that it can be explained by the certainty of purchase based on the price of goods. Experiment 1 replicated the previously reported difference in decision making, and additionally demonstrated that participants' certainty of purchase was lower for a high- than a low-price good. When it was emphasized that participants' intention to purchase high- and low-price goods were equally sure, decision making did not significantly differ (Experiment 2). Furthermore, decision making differed based only on the certainty of purchase even,when prices of goods were-same (Experiment 3). Consumers' decision making may be rather rational, depending straightforwardly on the certainty of purchase that is susceptible to price.

A General Bayesian Network Approach to Analyzing Online Game Item Values and Its Influence on Consumer Satisfaction and Purchase Intention

NASA Astrophysics Data System (ADS)

Lee, Kun Chang; Park, Bong-Won

Many online game users purchase game items with which to play free-to-play games. Because of a lack of research into which there is no specified framework for categorizing the values of game items, this study proposes four types of online game item values based on an analysis of literature regarding online game characteristics. It then proposes to investigate how online game users perceive satisfaction and purchase intention from the proposed four types of online game item values. Though regression analysis has been used frequently to answer this kind of research question, we propose a new approach, a General Bayesian Network (GBN), which can be performed in an understandable way without sacrificing predictive accuracy. Conventional techniques, such as regression analysis, do not provide significant explanation for this kind of problem because they are fixed to a linear structure and are limited in explaining why customers are likely to purchase game items and if they are satisfied with their purchases. In contrast, the proposed GBN provides a flexible underlying structure based on questionnaire survey data and offers robust decision support on this kind of research question by identifying its causal relationships. To illustrate the validity of GBN in solving the research question in this study, 327 valid questionnaires were analyzed using GBN with what-if and goal-seeking approaches. The experimental results were promising and meaningful in comparison with regression analysis results.

Procurement Cards Pave the Way to Efficient Purchasing.

ERIC Educational Resources Information Center

Enos, Eileen D.

1999-01-01

As educators battle restricted budgets, inflation, and enrollment changes, strategic sourcing management is replacing traditional transaction-based procurement. Procurement-card programs, allowing organizations to use credit cards for small purchases or low-value items, save time and enhance controls over merchants, credit limits, issuance limits,…

Consumer peach preferences and purchasing behavior: a mixed methods study.

PubMed

Kelley, Kathleen M; Primrose, Rachel; Crassweller, Robert; Hayes, John E; Marini, Richard

2016-05-01

Peaches (Prunus persica (L.) Stokes) are grown in several regions throughout the USA, are eaten fresh, and used as ingredients in value-added processed products. An Internet survey was conducted to investigate Mid-Atlantic consumers' fresh and processed peach purchasing behaviors, and whether packaging certain numbers of peaches together, providing information about nutritional content, and other factors would increase purchases. Additionally, laboratory-based sensory testing was used to better understand peel color, texture, sweetness, sourness, and flavor preferences for cultivars commonly grown in the Mid-Atlantic region. Irrespective of fresh peach consumption frequency, certain value-added products were of interest. For some products, interest in purchasing was higher than reported purchasing behavior. Preference for certain fresh peach characteristics, such as peel color, differed between less frequent fresh peach consumers and those who consumed fresh peaches more often. Of the four peach cultivars included in the sensory test, most were liked; however, there were some cultivar differences pertaining to color, texture, sweetness, tartness, and flavor liking. Potential marketing strategies can be developed based on frequency of fresh peach consumption and household demographics. Data can be used to select peaches that best appeal to consumers. © 2015 Society of Chemical Industry. © 2015 Society of Chemical Industry.

Genetically deprived vitamin D exposure predisposes to atrial fibrillation.

PubMed

Chan, Yap-Hang; Yiu, Kai-Hang; Hai, Jo Jo; Chan, Pak-Hei; Lam, Tai-Hing; Cowling, Ben J; Sham, Pak-Chung; Lau, Chu-Pak; Lam, Karen Siu-Ling; Siu, Chung-Wah; Tse, Hung-Fat

2017-12-01

Low vitamin D level is associated with atrial fibrillation (AF) and may be implicated in its pathogenesis. We studied single nucleotide polymorphisms (SNPs) of vitamin D mechanistic pathways and serum 25-hydroxyvitamin D [25(OH)D] levels in an age- and gender-matched case-control study (controls without AF: mean age 68.6 ± 8.7 years, female 25%; n = 1019; with AF: mean age 69.7 ± 9.5 years, female 30%; n = 156) recruited from a Chinese clinical cohort of patients with stable coronary artery disease. Twelve SNPs involved in the vitamin D mechanistic pathways were studied [biosynthetic: rs4646536, rs10877012, rs3829251, rs1790349; activation: rs2060793, rs1993116; vitamin D-binding protein (VBP)/group-specific component (GC): rs4588, rs7041, rs2282679, rs1155563; and vitamin D receptor: rs1544410, rs10735810]. A genetic risk score (GRS) (0-8) was constructed from SNPs associated with serum 25(OH)D as a proxy to lifelong vitamin D-deficient state. All 4 SNPs involved in the VBP/GC were significantly associated with serum 25(OH)D (rs4588, P < 0.001; rs2282679, P < 0.001; rs7041, P = 0.011; rs1155563, P < 0.001; all other SNPs, P > 0.05). Vitamin D GRS (points 0-8) generated from these 4 SNPs was independently predictive of serum 25(OH)D [B = 0.54, 95% confidence interval (CI) 0.30-0.79; P < 0.001]. Genetically deprived vitamin D status as denoted by a low GRS (0-3) independently predicted an increased risk of AF, compared to a high GRS (4-8) (odds ratio = 1.848, 95% CI 1.217-2.805; P = 0.004). Genetically deprived vitamin D exposure predisposes to increased AF among patients with coronary artery disease. Whether VBP/GC may alter the risk of AF via alternative mechanisms warrants further studies. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

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

NASA Astrophysics Data System (ADS)

Sri Yogi, Kottala

2018-03-01

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

Dissolution enhancement of atorvastatin calcium by co-grinding technique.

PubMed

Prabhu, Priyanka; Patravale, Vandana

2016-08-01

Atorvastatin calcium (AC) is a BCS class II drug which shows poor bioavailability due to inadequate dissolution. Solid dispersions present a promising option to enhance the solubility of poorly soluble drugs. Co-grinding with hydrophilic excipients is an easy and economical technique to improve the solubility of poorly soluble drugs and is free from usage of organic solvents. The aim of the present study was to explore novel carrier VBP-1 (organosulphur compound) for formulating a solid dispersion by using a simple, commercially viable co-grinding technique to enhance the dissolution of AC and to develop an oral formulation of the same. Composition of the solid dispersion was optimized based on the release profile in pH 1.2 buffer. The optimized solid dispersion was further characterized for flow properties, DSC, FTIR spectroscopy, XRD, contact angle, SEM studies and release profile in phosphate buffer pH 6.8. The developed solid dispersion gave similar release profile as the innovator formulation (Lipitor® tablets) in both pH 1.2 buffer and phosphate buffer pH 6.8. The developed solid dispersion was formulated into hard gelatin capsules (size 3). The developed capsules were found to give similar release as the innovator formulation in both pH 1.2 buffer and phosphate buffer pH 6.8. The developed capsules were found to be stable for a period of 6 months. Anti-hyperlipidemic efficacy studies in rats showed higher reduction in cholesterol and triglyceride levels by the developed capsules in comparison to pure AC. In conclusion, novel carrier VBP-1 was successfully employed to enhance the dissolution of AC using co-grinding technique.

Corner Store Purchases in a Low-Income Urban Community in NYC.

PubMed

Kiszko, Kamila; Cantor, Jonathan; Abrams, Courtney; Ruddock, Charmaine; Moltzen, Kelly; Devia, Carlos; McFarline, Bernice; Singh, Hardeep; Elbel, Brian

2015-12-01

We assessed purchases made, motivations for shopping, and frequency of shopping at four New York City corner stores (bodegas). Surveys and purchase inventories (n = 779) were collected from consumers at four bodegas in Bronx, NY. We use Chi square tests to compare types of consumers, items purchased and characteristics of purchases based on how frequently the consumer shops at the specific store and the time of day the purchase was made. Most consumers shopped at the bodega because it was close to their home (52 %). The majority (68 %) reported shopping at the bodega at least once per day. The five most commonly purchased items were sugary beverages, (29.27 %), sugary snacks (22.34 %), coffee, (13.99 %), sandwiches, (13.09 %) and non-baked potato chips (12.2 %). Nearly 60 % of bodega customers reported their purchase to be healthy. Most of the participants shopped at the bodega frequently, valued its convenient location, and purchased unhealthy items. Work is needed to discover ways to encourage healthier choices at these stores.

Making Wise Buys: Five Values to Consider when Evaluating a Library Purchase

ERIC Educational Resources Information Center

Durr, Chris

2011-01-01

Library staff members should ultimately base their purchasing choices on the mission statements of their employing institutions. Fortunately, library mission statements have much in common. Undoubtedly, for example, all libraries have a goal that includes "serve the information needs of the community," because on some level, all libraries are…

Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Policy Changes and Fiscal Year 2016 Rates; Revisions of Quality Reporting Requirements for Specific Providers, Including Changes Related to the Electronic Health Record Incentive Program; Extensions of the Medicare-Dependent, Small Rural Hospital Program and the Low-Volume Payment Adjustment for Hospitals. Final rule; interim final rule with comment period.

PubMed

2015-08-17

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2016. Some of these changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act), the Pathway for Sustainable Growth Reform(SGR) Act of 2013, the Protecting Access to Medicare Act of 2014, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Medicare Access and CHIP Reauthorization Act of 2015, and other legislation. We also are addressing the update of the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2016.As an interim final rule with comment period, we are implementing the statutory extensions of the Medicare dependent,small rural hospital (MDH)Program and changes to the payment adjustment for low-volume hospitals under the IPPS.We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2016 and implementing certain statutory changes to the LTCH PPS under the Affordable Care Act and the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013 and the Protecting Access to Medicare Act of 2014.In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific providers (acute care hospitals,PPS-exempt cancer hospitals, and LTCHs) that are participating in Medicare, including related provisions for eligible hospitals and critical access hospitals participating in the Medicare Electronic Health Record (EHR)Incentive Program. We also are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program.

Adding A Spending Metric To Medicare's Value-Based Purchasing Program Rewarded Low-Quality Hospitals.

PubMed

Das, Anup; Norton, Edward C; Miller, David C; Ryan, Andrew M; Birkmeyer, John D; Chen, Lena M

2016-05-01

In fiscal year 2015 the Centers for Medicare and Medicaid Services expanded its Hospital Value-Based Purchasing program by rewarding or penalizing hospitals for their performance on both spending and quality. This represented a sharp departure from the program's original efforts to incentivize hospitals for quality alone. How this change redistributed hospital bonuses and penalties was unknown. Using data from 2,679 US hospitals that participated in the program in fiscal years 2014 and 2015, we found that the new emphasis on spending rewarded not only low-spending hospitals but some low-quality hospitals as well. Thirty-eight percent of low-spending hospitals received bonuses in fiscal year 2014, compared to 100 percent in fiscal year 2015. However, low-quality hospitals also began to receive bonuses (0 percent in fiscal year 2014 compared to 17 percent in 2015). All high-quality hospitals received bonuses in both years. The Centers for Medicare and Medicaid Services should consider incorporating a minimum quality threshold into the Hospital Value-Based Purchasing program to avoid rewarding low-quality, low-spending hospitals. Project HOPE—The People-to-People Health Foundation, Inc.

42 CFR § 484.325 - Payments for home health services under Home Health Value-Based Purchasing (HHVBP) Model.

Code of Federal Regulations, 2010 CFR

2017-10-01

... Purchasing (HHVBP) Model. CMS will determine a payment adjustment up to the maximum applicable percentage... Total Performance Score using a linear exchange function. Payment adjustments made under the HHVBP Model... 42 Public Health 5 2017-10-01 2017-10-01 false Payments for home health services under Home Health...

42 CFR § 484.325 - Payments for home health services under Home Health Value-Based Purchasing (HHVBP) Model.

Code of Federal Regulations, 2010 CFR

2016-10-01

... Purchasing (HHVBP) Model. CMS will determine a payment adjustment up to the maximum applicable percentage... Total Performance Score using a linear exchange function. Payment adjustments made under the HHVBP Model... 42 Public Health 5 2016-10-01 2016-10-01 false Payments for home health services under Home Health...

An approach to value-based simulator selection: The creation and evaluation of the simulator value index tool.

PubMed

Rooney, Deborah M; Hananel, David M; Covington, Benjamin J; Dionise, Patrick L; Nykamp, Michael T; Pederson, Melvin; Sahloul, Jamal M; Vasquez, Rachael; Seagull, F Jacob; Pinsky, Harold M; Sweier, Domenica G; Cooke, James M

2018-04-01

Currently there is no reliable, standardized mechanism to support health care professionals during the evaluation of and procurement processes for simulators. A tool founded on best practices could facilitate simulator purchase processes. In a 3-phase process, we identified top factors considered during the simulator purchase process through expert consensus (n = 127), created the Simulator Value Index (SVI) tool, evaluated targeted validity evidence, and evaluated the practical value of this SVI. A web-based survey was sent to simulation professionals. Participants (n = 79) used the SVI and provided feedback. We evaluated the practical value of 4 tool variations by calculating their sensitivity to predict a preferred simulator. Seventeen top factors were identified and ranked. The top 2 were technical stability/reliability of the simulator and customer service, with no practical differences in rank across institution or stakeholder role. Full SVI variations predicted successfully the preferred simulator with good (87%) sensitivity, whereas the sensitivity of variations in cost and customer service and cost and technical stability decreased (≤54%). The majority (73%) of participants agreed that the SVI was helpful at guiding simulator purchase decisions, and 88% agreed the SVI tool would help facilitate discussion with peers and leadership. Our findings indicate the SVI supports the process of simulator purchase using a standardized framework. Sensitivity of the tool improved when factors extend beyond traditionally targeted factors. We propose the tool will facilitate discussion amongst simulation professionals dealing with simulation, provide essential information for finance and procurement professionals, and improve the long-term value of simulation solutions. Limitations and application of the tool are discussed. Copyright © 2017 Elsevier Inc. All rights reserved.

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

PubMed

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

2018-05-15

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

Mandatory bundled payment getting into formation for value-based care.

PubMed

Fink, John

2015-10-01

Succeeding under Medicare's enterprise Comprehensive Care for Joint Replacement Model will require collaboration among caregivers and financial arrangements to align incentives Priorities for most organization's transition to becoming a value-based hospitals will be care redesign, supply-purchasing strategy, and post-acute care provider partnering. Pursuing value for your joint replacement program will chart a path for other service lines and lead your organization's transition to becoming a value-based enterprise.

17 CFR 240.3b-13 - Definition of eligible OTC derivative instrument.

Code of Federal Regulations, 2012 CFR

2012-04-01

... purchase or sale of a security on a firm basis; or (2) Provides, in whole or in part, on a firm or... derivative instrument means any contract, agreement, or transaction that: (1) Provides, in whole or in part, on a firm or contingent basis, for the purchase or sale of, or is based on the value of, or any...

17 CFR 240.3b-13 - Definition of eligible OTC derivative instrument.

Code of Federal Regulations, 2013 CFR

2013-04-01

... purchase or sale of a security on a firm basis; or (2) Provides, in whole or in part, on a firm or... derivative instrument means any contract, agreement, or transaction that: (1) Provides, in whole or in part, on a firm or contingent basis, for the purchase or sale of, or is based on the value of, or any...

17 CFR 240.3b-13 - Definition of eligible OTC derivative instrument.

Code of Federal Regulations, 2014 CFR

2014-04-01

... purchase or sale of a security on a firm basis; or (2) Provides, in whole or in part, on a firm or... derivative instrument means any contract, agreement, or transaction that: (1) Provides, in whole or in part, on a firm or contingent basis, for the purchase or sale of, or is based on the value of, or any...

Proposal of a New SI Base Unit for Value. An Hedonic Estimation of the Physical Purchasing Power (PhPP) of Money.

NASA Astrophysics Data System (ADS)

Defilla, Steivan

2006-03-01

Hitherto, the purchasing power of money, i.e. its transaction value, has been measured in terms of inflation index numbers and consumer baskets. Consumer baskets are variable phenomena and their use as measurement units for value confuses the measuring with the measurand. We propose an invariant numeraire, or value unit, based on the market value of a Planck energy (1956 MJ). Planck units form a natural system of units independent of any civilization. The hedonic estimation of the PhPP of a currency differentiates energy by product as well as by thermodynamic quality (exergy). Following SI rules, we propose to name the value unit walras (Wal) in honour of the economist Leon Walras (1834 - 1910). One Wal can also be interpreted as the minimum cost of physiological life of a reference person during one year. The study uses official disaggregated Swiss Producer and Consumer Price Index data and estimates the PhPP of the Swiss franc in 2003.

Demographics and beef preferences affect consumer motivation for purchasing fresh beef steaks and roasts.

PubMed

Reicks, A L; Brooks, J C; Garmyn, A J; Thompson, L D; Lyford, C L; Miller, M F

2011-04-01

Surveys completed by 1370 consumers determined the motivational factors affecting consumer purchasing decisions for fresh beef steaks and roasts in three regions in the United States. Females placed greater importance on tenderness, ease of preparation, and nutritional value of steaks and roasts when compared to males. Age influenced tenderness, product consistency, and nutritional value of steaks, but influenced flavor, product consistency, and nutritional value of roasts. Consumers felt juiciness, nutritional value, and natural products were less important in determining their purchasing choices of steaks and roasts as their level of education increased. The preferred degree of doneness of steaks influenced the value placed on six of the nine purchasing motivators. Beef preferences and demographics influenced consumer purchasing decisions for fresh beef steaks and roasts. Results from this study can be used to help identify factors to positively influence purchasing decisions within targeted market segments. © 2010 The American Meat Science Association. Published by Elsevier Ltd. All rights reserved.

Purchases of ready-to-eat cereals vary across US household sociodemographic categories according to nutritional value and advertising targets.

PubMed

Castetbon, Katia; Harris, Jennifer L; Schwartz, Marlene B

2012-08-01

To describe ready-to-eat (RTE) cereal purchases in 2008 in the USA according to cereal nutritional quality and marketing strategy and household sociodemographic characteristics. Cross-sectional study of purchases in one year. Each type of cereal was assigned to one of four nutrition quality categories (based on Nutrient Profile Index, NPI) and one of four advertising categories based on television exposure and analysis of packaging (child-targeted, family-targeted, adult-targeted and no television advertising). Medians and distributions of purchase indicators were calculated for the cereal categories and the distributions were compared across sociodemographic groups. RTE cereals (n 249) with complete label and nutritional content. RTE cereal purchases according to household sociodemographic characteristics obtained from Nielsen Homescan, a nationally representative panel of households. Purchases of RTE cereals were highest in households with one or more child and lowest in African-American and Asian households, as well as those earning <$US 30 000 per annum. The lowest-quality products were purchased by four times as many households as the highest-quality cereals, but loyalty to these products was lower. Purchases of cereals by households with children and in African-American and Hispanic households increased as cereal nutritional quality declined. Compared with non-advertised products, advertised child-targeted cereals were purchased thirteen times more frequently; family-targeted brand purchases were ten times higher; and adult-targeted cereals were purchased four times more frequently. Our findings suggest that improving the nutritional quality of RTE cereals with advertising targeted to children could also lead to increased consumption of healthier products by young people.

17 CFR 270.23c-1 - Repurchase of securities by closed-end companies.

Code of Federal Regulations, 2010 CFR

2010-04-01

... issuer. (5) Payment of the purchase price is accompanied or preceded by a written confirmation of the purchase. (6) The purchase is made at a price not above the market value, if any, or the asset value of..., within the preceding six months, informed stockholders of its intention to purchase stock of such class...

Demographic and psychographic associations of consumer intentions to purchase healthier food products.

PubMed

Burton, Melissa; Wang, Wei Chun; Worsley, Anthony

2015-01-01

This study investigated the associations of nutrition concerns, demographics, universalism (community oriented) values, perceived control over personal health and food buying, and perceived influence over the food system with intentions to purchase low fat, sugar and salt (LFSS) food products. A national online survey of 2204 Australian consumers administered in November 2011. Structural equation modeling was used to examine associations of LFSS purchasing intentions with demographic, values, perceived control, and influence factors. Nutrition concern, perceived influence over the food system, and universalism values were key predictors of LFSS purchasing intentions. Almost two thirds (64.6%) of the variance associated with LFSS purchasing was explained by the structural equation model. Communication programs which focus on universalism values, nutrition concern and perceived influence over the food system are likely to increase LFSS purchasing and perhaps reduce the demand for energy dense, nutrient poor foods.

Demographic and psychographic associations of consumer intentions to purchase healthier food products

PubMed Central

Burton, Melissa; Wang, Wei Chun; Worsley, Anthony

2014-01-01

Objective This study investigated the associations of nutrition concerns, demographics, universalism (community oriented) values, perceived control over personal health and food buying, and perceived influence over the food system with intentions to purchase low fat, sugar and salt (LFSS) food products. Methods A national online survey of 2204 Australian consumers administered in November 2011. Structural equation modeling was used to examine associations of LFSS purchasing intentions with demographic, values, perceived control, and influence factors. Results Nutrition concern, perceived influence over the food system, and universalism values were key predictors of LFSS purchasing intentions. Almost two thirds (64.6%) of the variance associated with LFSS purchasing was explained by the structural equation model. Conclusion Communication programs which focus on universalism values, nutrition concern and perceived influence over the food system are likely to increase LFSS purchasing and perhaps reduce the demand for energy dense, nutrient poor foods. PMID:26844047

THE ROLE OF CONSUMER VALUES AND SOCIO-DEMOGRAPHICS IN GREEN PRODUCT SATISFACTION: THE CASE OF HYBRID CARS.

PubMed

Hur, Won-Moo; Woo, Jeong; Kim, Yeonshin

2015-10-01

This study investigated the relationship between consumer value and customer satisfaction, seeking a better understanding of the motivations underlying "green product" purchases. Based on the influence of demographic factors, it further explores the moderation effects of buyers' socio-demographics on the link between value and satisfaction. Data were collected through a mail survey of American hybrid car buyers. Consumer value, satisfaction, and socio-demographic information were measured, and the proposed relationships among them were tested using hierarchical multiple regression analysis. This study's findings reveal that values (i.e., functional and social) significantly impact hybrid satisfaction and that the effects vary by sex and age. This research provides insight into the motivations of green product purchases by incorporating important consumer characteristics.

Hospital Value-Based Purchasing: The Association Between Patient Experience and Clinical Outcome.

PubMed

Haley, D Rob; Hamadi, Hanadi; Zhao, Mei; Xu, Jing; Wang, Yi

The Affordable Care Act of 2010 introduced a Hospital Value-Based Purchasing Total Performance Score for payment purposes and to evaluate hospital quality of care. In fiscal year 2016, Total Performance Score was composed of (1) Clinical Processes of Care, (2) Patient Experience of Care, (3) Outcome, and (4) Efficiency domains. The objective of this study was to examine the association between the Patient Experience of Care and Outcome domains. The Donabedian model of structure, process, and outcome was used as a conceptual framework for this study. Data from the 2015-2016 Area Health Resource File, the 2016 American Hospital Association database, and the 2016 Hospital Value-Based Purchasing were used. Univariate, bivariate, and multivariate analyses were conducted to examine the impact of patient experience on outcome of care and hospitals. From a sample of 1866 hospitals across the United States, patient experience was significantly and positively associated with patient outcome. In addition, for-profit hospitals, hospitals with more beds, nonteaching hospitals, and hospitals located in less competitive markets were found to have a significant association with better outcomes. The study's findings are important as policy makers consider additional or alternative indicators that may better represent and encourage higher quality of care within acute care hospitals.

Hospital Value-Based Purchasing Performance: Do Organizational and Market Characteristics Matter?

PubMed

Spaulding, Aaron; Edwardson, Nick; Zhao, Mei

The hospital value-based purchasing (HVBP) program of the Centers for Medicare & Medicaid Services challenges hospitals to deliver high-quality care or face a reduction in Medicare payments. How do different organizational structures and market characteristics enable or inhibit successful transition to this new model of value-based care? To address that question, this study employs an institutional theory lens to test whether certain organizational structures and market characteristics mediate hospitals' ability to perform across HVBP domains.Data from the 2014 American Hospital Association Annual Survey Database, Area Health Resource File, the Medicare Hospital Compare Database, and the association between external environment and hospital performance are assessed through multiple regression analysis. Results indicate that hospitals that belong to a system are more likely than independent hospitals to score highly on the domains associated with the HVBP incentive arrangement. However, varying and sometimes counterintuitive market influences bring different dimensions to the HVBP program. A hospital's ability to score well in this new value arrangement may be heavily based on the organization's ability to learn from others, implement change, and apply the appropriate amount of control in various markets.

The Defense Logistics Agency Properly Awarded Power Purchase Agreements and the Army Obtained Fair Market Value for Leases Supporting Power Purchase Agreements

DTIC Science & Technology

2016-09-28

Fair Market Value for Leases Supporting Power Purchase Agreements I N T E G R I T Y  E F F I C I E N C Y  A C C O U N T A B I L I T Y  E X... Market Value for Leases Supporting Power Purchase Agreements Visit us at www.dodig.mil September 28, 2016 Objective We determined whether the...Department of the Army properly awarded and obtained fair market value for leases supporting energy production projects. We conducted this audit in

26 CFR 1.163-10T - Qualified residence interest (temporary).

Code of Federal Regulations, 2013 CFR

2013-04-01

...)Example. (6)Highest principal balance. (7)Other methods provided by the Commissioner. (8)Anti-abuse rule... adjusted purchase price and fair market value. (1)Adjusted purchase price. (i)In general. (ii)Adjusted purchase price of a qualified residence acquired incident to divorce. (iii)Examples. (2)Fair market value...

26 CFR 1.163-10T - Qualified residence interest (temporary).

Code of Federal Regulations, 2014 CFR

2014-04-01

...)Example. (6)Highest principal balance. (7)Other methods provided by the Commissioner. (8)Anti-abuse rule... adjusted purchase price and fair market value. (1)Adjusted purchase price. (i)In general. (ii)Adjusted purchase price of a qualified residence acquired incident to divorce. (iii)Examples. (2)Fair market value...

26 CFR 1.163-10T - Qualified residence interest (temporary).

Code of Federal Regulations, 2012 CFR

2012-04-01

...)Example. (6)Highest principal balance. (7)Other methods provided by the Commissioner. (8)Anti-abuse rule... adjusted purchase price and fair market value. (1)Adjusted purchase price. (i)In general. (ii)Adjusted purchase price of a qualified residence acquired incident to divorce. (iii)Examples. (2)Fair market value...

30 CFR 206.53 - How do I determine value for oil that I or my affiliate do(es) not sell under an arm's-length...

Code of Federal Regulations, 2010 CFR

2010-07-01

..., from the property where it is produced to the point where you or your affiliate purchase(s) it. You may..., for purchases or sales under arm's-length contracts. (1) When calculating that unit value, use only purchases or sales of other like-quality oil produced from the field (or the same area if you do not have...

40 CFR 600.306-08 - Labeling requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... which has a combined FTP/HFET-based fuel economy value, as determined in § 600.513-08, at or below the...) Have not been delivered to the ultimate purchaser, and (B) Have a combined FTP/HFET-based model type...

The Eye of the Beholder: A Discussion of Value and Quality From the Perspective of Families of Children and Youth With Special Health Care Needs.

PubMed

Anderson, Betsy; Beckett, Julie; Wells, Nora; Comeau, Meg

2017-05-01

There is broad agreement that increasing the cost-effectiveness and quality of health care services, thereby achieving greater value, is imperative given this country's current spiraling costs and poor health outcomes. However, how individuals or stakeholder groups define value may differ significantly. Discussion of value in the context of health care, in particular value-based purchasing and value-based insurance design, must acknowledge that there is no universal consensus definition as to what constitutes value. To date, the consumer perspective has been underrepresented in discussions of value-based strategies such as pay for performance, capitated and bundled payments, and high-deductible health plans, which have been driven primarily by payers and providers. This article will discuss 3 elements of value from the perspective of families of children and youth with special health care needs: the role of families in the delivery of care, consumer perspectives on what constitutes quality for children and youth with special health care needs, and health care and health care financing literacy, decision-making, and costs. The undervalued contributions made by family members in the delivery and oversight of pediatric care and the importance of partnering with them to achieve the goals of the Triple Aim are stressed. The article closes with a discussion of recommendations for a future policy and research agenda related to advancing the integration of the consumer perspective into value-based purchasing and value-based insurance design. Copyright © 2017 by the American Academy of Pediatrics.

Episode-Based Payment and Direct Employer Purchasing of Healthcare Services: Recent Bundled Payment Innovations and the Geisinger Health System Experience.

PubMed

Slotkin, Jonathan R; Ross, Olivia A; Newman, Eric D; Comrey, Janet L; Watson, Victoria; Lee, Rachel V; Brosious, Megan M; Gerrity, Gloria; Davis, Scott M; Paul, Jacquelyn; Miller, E Lynn; Feinberg, David T; Toms, Steven A

2017-04-01

One significant driver of the disjointed healthcare often observed in the United States is the traditional fee-for-service payment model which financially incentivizes the volume of care delivered over the quality and coordination of care. This problem is compounded by the wide, often unwarranted variation in healthcare charges that purchasers of health services encounter for substantially similar episodes of care. The last 10 years have seen many stakeholder organizations begin to experiment with novel financial payment models that strive to obviate many of the challenges inherent in customary quantity-based cost paradigms. The Patient Protection and Affordable Care Act has allowed many care delivery systems to partner with Medicare in episode-based payment programs such as the Bundled Payments for Care Improvement (BPCI) initiative, and in patient-based models such as the Medicare Shared Savings Program. Several employer purchasers of healthcare services are experimenting with innovative payment models to include episode-based bundled rate destination centers of excellence programs and the direct purchasing of accountable care organization services. The Geisinger Health System has over 10 years of experience with episode-based payment bundling coupled with the care delivery reengineering which is integral to its ProvenCare® program. Recent experiences at Geisinger have included participation in BPCI and also partnership with employer-purchasers of healthcare through the Pacific Business Group on Health (representing Walmart, Lowe's, and JetBlue Airways). As the shift towards value-focused care delivery and patient experience progresses forward, bundled payment arrangements and direct purchasing of healthcare will be critical financial drivers in effecting change. Copyright © 2017 by the Congress of Neurological Surgeons.

Lease VS Purchase Analysis of Alternative Fuel Vehicles in the United States Marine Corps

DTIC Science & Technology

2009-10-30

the light-duty category and then apply a model that will compare the two alternatives based on their relative net present values. An aggregated view of... model that will compare the two alternatives based on their relative net present values. An aggregated view of several different light-duty AFV...Summary .......................................................................................32  IV.  The Model

30 CFR 1206.301 - Value basis for royalty computation.

Code of Federal Regulations, 2011 CFR

2011-07-01

... royalty computation. (a) The gross value for royalty purposes shall be the sale or contract unit price...) That a contract of sale or other business arrangement between the lessee and a purchaser of some or all... because it is based in whole or in part upon considerations other than the value of the commodities, or (2...

Waiting for Merlot: anticipatory consumption of experiential and material purchases.

PubMed

Kumar, Amit; Killingsworth, Matthew A; Gilovich, Thomas

2014-10-01

Experiential purchases (money spent on doing) tend to provide more enduring happiness than material purchases (money spent on having). Although most research comparing these two types of purchases has focused on their downstream hedonic consequences, the present research investigated hedonic differences that occur before consumption. We argue that waiting for experiences tends to be more positive than waiting for possessions. Four studies demonstrate that people derive more happiness from the anticipation of experiential purchases and that waiting for an experience tends to be more pleasurable and exciting than waiting to receive a material good. We found these effects in studies using questionnaires involving a variety of actual planned purchases, in a large-scale experience-sampling study, and in an archival analysis of news stories about people waiting in line to make a purchase. Consumers derive value from anticipation, and that value tends to be greater for experiential than for material purchases. © The Author(s) 2014.

Encouraging use of coupons to stimulate condom purchase.

PubMed Central

Dahl, D W; Gorn, G J; Weinberg, C B

1999-01-01

OBJECTIVES: This study examined the feasibility of using high-value coupons to induce condom purchase and evaluated execution factors that can influence the effectiveness of this form of promotion. METHODS: Two levels of coupon discount value (10% off and 75% off) were used to promote condom purchase among young adults. Coupons were distributed according to a widespread strategy or a more focused in-store disbursement method. RESULTS: Redemption of coupons distributed through the widespread disbursement strategy was negligible. In contrast, coupons from the in-store distribution method, particularly the higher value coupon, resulted in a high redemption rate. CONCLUSIONS: This research provides strong evidence that discount coupons, particularly high-value ones distributed at the purchase location, can be used successfully as a condom promotional incentive. PMID:10589320

"Whether something cool is good enough": The role of evidence, sales representatives and nurses' expertise in hospital purchasing decisions.

PubMed

Grundy, Quinn

2016-09-01

The emphasis on "value" within healthcare institutions has achieved unprecedented priority, particularly around the purchase of medical products and equipment. Health systems and institutions are implementing formal decision-making processes involving clinicians and supply chain professionals to rationalize purchasing and promote cost-effective investment. One particular form of this process is the "Value Analysis" process. Drawing from fieldwork (100 h), interviews (n = 51) and focus groups (n = 4) conducted from January 2012 to October 2014 at 4 acute care hospitals in the western United States, I analyze the ways that committee members constructed and evaluated a case for a product's value. Participants (n = 72) were a purposive sample including nurses, administrators, supply chain and industry professionals. Interpretive phenomenology served as the analytic approach to generating iterative themes. While trying to be evidence-based, Value Analysis committees lacked data related to a product's price or efficacy and relied heavily on local knowledge and expertise. Sales representatives were an integral part of the process, creating interest in the product and providing product information. As vehicles for cost-savings and quality improvement, purchasing committees need unique support that emphasizes local contexts and expertise, while maintaining rigor and minimizing bias. Drawing from participants' experiences, and principles of health technology assessment and economic evaluation, a guiding framework is proposed to support this decision-making. Copyright © 2016 Elsevier Ltd. All rights reserved.

U.S. Residential Photovoltaic (PV) System Prices, Q4 2013 Benchmarks: Cash Purchase, Fair Market Value, and Prepaid Lease Transaction Prices

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

Davidson, C.; James, T. L.; Margolis, R.

The price of photovoltaic (PV) systems in the United States (i.e., the cost to the system owner) has dropped precipitously in recent years, led by substantial reductions in global PV module prices. This report provides a Q4 2013 update for residential PV systems, based on an objective methodology that closely approximates the book value of a PV system. Several cases are benchmarked to represent common variation in business models, labor rates, and module choice. We estimate a weighted-average cash purchase price of $3.29/W for modeled standard-efficiency, polycrystalline-silicon residential PV systems installed in the United States. This is a 46% declinemore » from the 2013-dollar-adjusted price reported in the Q4 2010 benchmark report. In addition, this report frames the cash purchase price in the context of key price metrics relevant to the continually evolving landscape of third-party-owned PV systems by benchmarking the minimum sustainable lease price and the fair market value of residential PV systems.« less

78 FR 46799 - Use of Market Economy Input Prices in Nonmarket Economy Proceedings

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-02

...The Department of Commerce (``Department'') is modifying its regulation which states that the Department normally will use the price that a nonmarket economy (``NME'') producer pays to a market economy supplier when a factor of production is purchased from a market economy supplier and paid for in market economy currency, in the calculation of normal value (``NV'') in antidumping proceedings involving NME countries. The rule establishes a requirement that the input at issue be produced in one or more market economy countries, and a revised threshold requiring that ``substantially all'' (i.e., 85 percent) of an input be purchased from one or more market economy suppliers before the Department uses the purchase price paid to value the entire factor of production. The Department is making this change because it finds that a market economy input price is not the best available information for valuing all purchases of that input when market economy purchases of an input do not account for substantially all purchases of the input.

The attentional drift-diffusion model extends to simple purchasing decisions.

PubMed

Krajbich, Ian; Lu, Dingchao; Camerer, Colin; Rangel, Antonio

2012-01-01

How do we make simple purchasing decisions (e.g., whether or not to buy a product at a given price)? Previous work has shown that the attentional drift-diffusion model (aDDM) can provide accurate quantitative descriptions of the psychometric data for binary and trinary value-based choices, and of how the choice process is guided by visual attention. Here we extend the aDDM to the case of purchasing decisions, and test it using an eye-tracking experiment. We find that the model also provides a reasonably accurate quantitative description of the relationship between choice, reaction time, and visual fixations using parameters that are very similar to those that best fit the previous data. The only critical difference is that the choice biases induced by the fixations are about half as big in purchasing decisions as in binary choices. This suggests that a similar computational process is used to make binary choices, trinary choices, and simple purchasing decisions.

The Attentional Drift-Diffusion Model Extends to Simple Purchasing Decisions

PubMed Central

Krajbich, Ian; Lu, Dingchao; Camerer, Colin; Rangel, Antonio

2012-01-01

How do we make simple purchasing decisions (e.g., whether or not to buy a product at a given price)? Previous work has shown that the attentional drift-diffusion model (aDDM) can provide accurate quantitative descriptions of the psychometric data for binary and trinary value-based choices, and of how the choice process is guided by visual attention. Here we extend the aDDM to the case of purchasing decisions, and test it using an eye-tracking experiment. We find that the model also provides a reasonably accurate quantitative description of the relationship between choice, reaction time, and visual fixations using parameters that are very similar to those that best fit the previous data. The only critical difference is that the choice biases induced by the fixations are about half as big in purchasing decisions as in binary choices. This suggests that a similar computational process is used to make binary choices, trinary choices, and simple purchasing decisions. PMID:22707945

Merit-Based Incentive Payment System (MIPS): Harsh Choices For Interventional Pain Management Physicians.

PubMed

Manchikanti, Laxmaiah; Helm Ii, Standiford; Benyamin, Ramsin M; Hirsch, Joshua A

2016-01-01

The Merit-based Incentive Payment System (MIPS) was created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to improve the health of all Americans by providing incentives and policies to improve patient health outcomes. MIPS combines 3 existing programs, Meaningful Use (MU), now called Advancing Care Information (ACI), contributing 25% of the composite score; Physician Quality Reporting System (PQRS), changed to Quality, contributing 50% of the composite score; and Value-based Payment (VBP) system to Resource Use or cost, contributing 10% of the composite score. Additionally, Clinical Practice Improvement Activities (CPIA), contributing 15% of the composite score, create multiple strategic goals to design incentives that drive movement toward delivery system reform principles with inclusion of Advanced Alternative Payment Models (APMs). Under the present proposal, the Centers for Medicare and Medicaid Services (CMS) has estimated approximately 30,000 to 90,000 providers from a total of over 761,000 providers will be exempt from MIPS. About 87% of solo practitioners and 70% of practitioners in groups of less than 10 will be subjected to negative payments or penalties ranging from 4% to 9%. In addition, MIPS also will affect a provider's reputation by making performance measures accessible to consumers and third-party physician rating Web sites.The MIPS composite performance scoring method, at least in theory, utilizes weights for each performance category, exceptional performance factors to earn bonuses, and incorporates the special circumstances of small practices.In conclusion, MIPS has the potential to affect practitioners negatively. Interventional Pain Medicine practitioners must understand the various MIPS measures and how they might participate in order to secure a brighter future. Medicare Access and CHIP Reauthorization Act of 2015, merit-based incentive payment system, quality performance measures, resource use, clinical practice improvement activities, advancing care information performance category.

26 CFR 1.44-5 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... case of factory-made homes the adjusted basis includes furniture only where it is included in the base... the amount of the excess of the fair market value of such other property received over the amount, if... new car with a fair market value of $2,500 upon the purchase of a condominium apartment for a total...

7 CFR 624.10 - Floodplain easements.

Code of Federal Regulations, 2010 CFR

2010-01-01

...) General. NRCS may purchase floodplain easements as an emergency measure. NRCS will only purchase easements... of NRCS, of the floodplain's functions and values; or (iii) The purchase of an easement would not... the right not to purchase an easement if the easement compensation for a particular easement would be...

40 CFR 312.29 - The relationship of the purchase price to the value of the property, if the property was not...

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 27 2010-07-01 2010-07-01 false The relationship of the purchase price... COMMUNITY RIGHT-TO-KNOW PROGRAMS INNOCENT LANDOWNERS, STANDARDS FOR CONDUCTING ALL APPROPRIATE INQUIRIES Standards and Practices § 312.29 The relationship of the purchase price to the value of the property, if the...

How Can Adult Children Influence Parents’ Long-Term Care Insurance Purchase Decisions?

PubMed Central

Voils, Corrine I.; Coe, Norma B.; Konetzka, R. Tamara; Boles, Jillian; Van Houtven, Courtney Harold

2017-01-01

Abstract Purpose of the Study: Long-term care (LTC) poses a significant strain on public health insurance financing. In response, there is policy interest in bolstering the private long-term care insurance (LTCI) market. Although families are central to LTC provision, their role in LTCI demand remains unclear. The purpose of this study was to obtain in-depth information concerning: (a) How do older parents evaluate the need for LTCI, (b) what role do adult children play? and (c) How do families communicate about parents’ LTC preferences and plans, including LTCI purchase? Design and Methods: We conducted focus groups with older parents and adult children in diverse markets. Two groups were conducted with older parents who had purchased LTCI and two with parents who had not purchased LTCI. Four groups were conducted with adult children, mixed as to whether their parents had purchased LTCI. Probes were informed by published reasons for purchasing or not purchasing LTCI. We analyzed transcriptions using directed content analysis and constant comparative method. Results: Older parents valued autonomy for themselves and their children. Older parent purchasers regarded LTCI as supporting this value while nonpurchasers perceived limitations. Adult children described unstated expectations that they would care for their parents. Though discussions between parents and children about LTCI were rare, successful influence occurred when children appealed to shared values, specifically avoiding burden and remaining home. Implications: Messages that emphasize autonomy over LTC decisions and interventions that start the LTC conversation among families, with attention to shared values, could increase private LTCI uptake. PMID:25209446

Should general practitioners purchase health care for their patients? The total purchasing experiment in Britain.

PubMed

Wyke, Sally; Mays, Nicholas; Street, Andrew; Bevan, Gwyn; McLeod, Hugh; Goodwin, Nick

2003-09-01

Until relatively recently, general practitioners (GPs) have been allowed to work independently, with no requirement to consider the resource implications of their referral and prescribing decisions. In order to align the interests of GPs with the overall objectives of health systems a number of countries have introduced primary care based capitation, funds pooling and budget holding either as experiments or as an overall policy. Are these experiments and policies likely to work? This paper presents evidence from the UK total purchasing experiment, which was the first major quasi-market development in the NHS to be independently evaluated from the outset. Total purchasing gave volunteer groups of practices freedom to purchase all hospital and community health services for their patients. The evidence suggests that whilst GPs have great potential as purchasers, they also have considerable limitations. The expectation that they will be able to improve the quality of patient experience of care, or to alter the use of resources, may not be generally realised. GP-based purchasing may be more appropriate where the task is to alter the balance or location of care between hospital and extramural settings. However, budgetary incentives are not 'magic potions' which have similar effects on behaviour wherever they are introduced. Holding budgets and having independent contracts, while important pre-requisites for being taken seriously in a quasi-market, were not sufficient for effective total purchasing. The paper concludes that health systems should not only value innovation and experimentation and encourage learning from evaluative research; they should also recognise the importance of supportive circumstances for any innovation to effect real and sustained change.

Merit-Based Incentive Payment System: Meaningful Changes in the Final Rule Brings Cautious Optimism.

PubMed

Manchikanti, Laxmaiah; Helm Ii, Standiford; Calodney, Aaron K; Hirsch, Joshua A

2017-01-01

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) eliminated the flawed Sustainable Growth Rate (SGR) act formula - a longstanding crucial issue of concern for health care providers and Medicare beneficiaries. MACRA also included a quality improvement program entitled, "The Merit-Based Incentive Payment System, or MIPS." The proposed rule of MIPS sought to streamline existing federal quality efforts and therefore linked 4 distinct programs into one. Three existing programs, meaningful use (MU), Physician Quality Reporting System (PQRS), value-based payment (VBP) system were merged with the addition of Clinical Improvement Activity category. The proposed rule also changed the name of MU to Advancing Care Information, or ACI. ACI contributes to 25% of composite score of the four programs, PQRS contributes 50% of the composite score, while VBP system, which deals with resource use or cost, contributes to 10% of the composite score. The newest category, Improvement Activities or IA, contributes 15% to the composite score. The proposed rule also created what it called a design incentive that drives movement to delivery system reform principles with the inclusion of Advanced Alternative Payment Models (APMs).Following the release of the proposed rule, the medical community, as well as Congress, provided substantial input to Centers for Medicare and Medicaid Services (CMS),expressing their concern. American Society of Interventional Pain Physicians (ASIPP) focused on 3 important aspects: delay the implementation, provide a 3-month performance period, and provide ability to submit meaningful quality measures in a timely and economic manner. The final rule accepted many of the comments from various organizations, including several of those specifically emphasized by ASIPP, with acceptance of 3-month reporting period, as well as the ability to submit non-MIPS measures to improve real quality and make the system meaningful. CMS also provided a mechanism for physicians to avoid penalties for non-reporting with reporting of just a single patient. In summary, CMS has provided substantial flexibility with mechanisms to avoid penalties, reporting for 90 continuous days, increasing the low volume threshold, changing the reporting burden and data thresholds and, finally, coordination between performance categories. The final rule has made MIPS more meaningful with bonuses for exceptional performance, the ability to report for 90 days, and to report on 50% of the patients in 2017 and 60% of the patients in 2018. The final rule also reduced the quality measures to 6, including only one outcome or high priority measure with elimination of cross cutting measure requirement. In addition, the final rule reduced the burden of ACI, improved the coordination of performance, reduced improvement activities burden from 60 points to 40 points, and finally improved coordination between performance categories. Multiple concerns remain regarding the reduction in scoring for quality improvement in future years, increase in proportion of MIPS scoring for resource use utilizing flawed, claims based methodology and the continuation of the disproportionate importance of ACI, an expensive program that can be onerous for providers which in many ways has not lived up to its promise. Key words: Medicare Access and CHIP Reauthorization Act of 2015, merit-based incentive payment system, quality performance measures, resource use, improvement activities, advancing care information performance category.

The accuracy of stated energy contents of reduced-energy, commercially prepared foods

USDA-ARS?s Scientific Manuscript database

The accuracy of stated energy contents of reduced calorie restaurant foods and frozen meals purchased from supermarkets was evaluated. Measured energy values of 29 quick-serve and sit-down restaurant foods averaged 18% more than stated values, and measured energy values of 10 frozen meals purchased ...

7 CFR 1485.23 - Miscellaneous provisions.

Code of Federal Regulations, 2012 CFR

2012-01-01

...., participation fees, proceeds of sales, refunds of value added taxes (VAT), the expenditures for which have been... goods with a value of $100 acquired in furtherance of program activities. The inventory shall list and number each item and include the date of purchase or acquisition, cost of purchase, replacement value...

Evaluating group purchasing organizations.

PubMed

Kaldor, Dennis C; Kowalski, Jamie C; Tankersley, Mark A

2003-01-01

A formal evaluation process can help healthcare organizations assess the current and/or potential value of a group purchasing organization (GPO). Healthcare organizations should approach a GPO evaluation as if they were entering into a new relationship. The evaluation should include purchasing and financial services, value-added services, and corporate relations/business practices. Healthcare organizations should consider the potential economies of scale and other services offered by a GPO. Healthcare organizations should consider using acceptable substitutes for products currently used or seeking products through alternative sources if doing so achieves greater value.

77 FR 31912 - Proposed Collection; Comment Request for Form 712

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-30

... gross estate and to determine the value of the policy for estate and gift tax purposes. The tax is based... of operation, maintenance, and purchase of services to provide information. Approved: May 22, 2012...

Messy but Fair: The ACA's Hospital Value-Based Purchasing Program and the Notice-and-Comment Process.

PubMed

Pan, Janus

2017-01-01

The Centers for Medicare and Medicaid Services (CMS) promulgated a new Medicare program called the Value-Based Purchasing Program (VBPP) as part of the 2010 Affordable Care Act (ACA). Like many other regulatory agencies, CMS used the Notice-and-Comment process to issue proposed rules, solicit public comments, and then publish final rules. Conventional literature suggests that CMS should disproportionately favor business interests during the Notice-and-Comment process, mainly due to the business interests' greater resources and capacity to draft well-reasoned comments. However, this article argues against this presumption and contends instead that CMS listens equally well to both business interest comments and private citizen comments during the formation of the VBPP. With regard to the VBPP and the ACA, CMS appears to be resisting disproportionate sway by business interests and is instead privileging the ACA's goal of improving healthcare quality.

Affordability, accountability, and accessibility in health care reform: implications for cardiovascular and pulmonary rehabilitation.

PubMed

King, Marjorie L

2013-01-01

Because health care costs in the United States have been growing disproportionately compared to inflation for many years, without a clear connection to improved quality or increased access to care, employers and payers have begun to test new models of health care delivery and payment. These models are linked to the concepts of affordability, accountability, and accessibility and incorporate the premise that there must be shared responsibility for improving meaningful patient outcomes, with attention to the coordination of team-based and patient-centered care, and value for services purchased. This article explores emerging health care delivery and payment models, including expanded access to care related to the Affordable Care Act of 2010, patient-centered medical homes and neighborhoods, accountable and coordinated care organizations, and value-based purchasing and insurance design, with an emphasis on implications for cardiovascular and pulmonary rehabilitation programs and the American Association of Cardiovascular and Pulmonary Rehabilitation.

Evaluative Usage-Based Metrics for the Selection of E-Journals.

ERIC Educational Resources Information Center

Hahn, Karla L.; Faulkner, Lila A.

2002-01-01

Explores electronic journal usage statistics and develops three metrics and three benchmarks based on those metrics. Topics include earlier work that assessed the value of print journals and was modified for the electronic format; the evaluation of potential purchases; and implications for standards development, including the need for content…

How Can Adult Children Influence Parents' Long-Term Care Insurance Purchase Decisions?

PubMed

Sperber, Nina R; Voils, Corrine I; Coe, Norma B; Konetzka, R Tamara; Boles, Jillian; Van Houtven, Courtney Harold

2017-04-01

Long-term care (LTC) poses a significant strain on public health insurance financing. In response, there is policy interest in bolstering the private long-term care insurance (LTCI) market. Although families are central to LTC provision, their role in LTCI demand remains unclear. The purpose of this study was to obtain in-depth information concerning: (a) How do older parents evaluate the need for LTCI, (b) what role do adult children play? and (c) How do families communicate about parents' LTC preferences and plans, including LTCI purchase? We conducted focus groups with older parents and adult children in diverse markets. Two groups were conducted with older parents who had purchased LTCI and two with parents who had not purchased LTCI. Four groups were conducted with adult children, mixed as to whether their parents had purchased LTCI. Probes were informed by published reasons for purchasing or not purchasing LTCI. We analyzed transcriptions using directed content analysis and constant comparative method. Older parents valued autonomy for themselves and their children. Older parent purchasers regarded LTCI as supporting this value while nonpurchasers perceived limitations. Adult children described unstated expectations that they would care for their parents. Though discussions between parents and children about LTCI were rare, successful influence occurred when children appealed to shared values, specifically avoiding burden and remaining home. Messages that emphasize autonomy over LTC decisions and interventions that start the LTC conversation among families, with attention to shared values, could increase private LTCI uptake. © The Author 2014. 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.

41 CFR 102-73.130 - When may Federal agencies consider acquiring leases with purchase options?

Code of Federal Regulations, 2010 CFR

2010-07-01

... consider leasing with a purchase option at or below fair market value, consistent with the lease-purchase... and other advantages to the Government and is consistent with the Government's goals. (b) The...

12 CFR 1.3 - Limitations on dealing in, underwriting, and purchase and sale of securities.

Code of Federal Regulations, 2013 CFR

2013-01-01

... security. (2) The aggregate par value of securities treated as investment securities under paragraph (i)(1... its own account, provided the aggregate par value of Type II securities issued by any one obligor held... may purchase and sell Type III securities for its own account, provided the aggregate par value of...

12 CFR 1.3 - Limitations on dealing in, underwriting, and purchase and sale of securities.

Code of Federal Regulations, 2011 CFR

2011-01-01

... the obligor will be able to satisfy its obligations under that security. (2) The aggregate par value... its own account, provided the aggregate par value of Type II securities issued by any one obligor held... may purchase and sell Type III securities for its own account, provided the aggregate par value of...

12 CFR 1.3 - Limitations on dealing in, underwriting, and purchase and sale of securities.

Code of Federal Regulations, 2014 CFR

2014-01-01

... security. (2) The aggregate par value of securities treated as investment securities under paragraph (i)(1... its own account, provided the aggregate par value of Type II securities issued by any one obligor held... may purchase and sell Type III securities for its own account, provided the aggregate par value of...

12 CFR 1.3 - Limitations on dealing in, underwriting, and purchase and sale of securities.

Code of Federal Regulations, 2012 CFR

2012-01-01

... the obligor will be able to satisfy its obligations under that security. (2) The aggregate par value... its own account, provided the aggregate par value of Type II securities issued by any one obligor held... may purchase and sell Type III securities for its own account, provided the aggregate par value of...

The Value of Timber Inventory Information.

Treesearch

B.E. Borders; W.M. Harrison; M.L. Clutter; B.D. Shiver; R.A. Souter

2008-01-01

Timber inventory data is the basis for many monetary transactions related to timber and timberland sale and (or) purchase as well as for development of timber management plans. The value of such data is well known and much appreciated for sale and (or) purchase of standing merchantable timber.  Unfortunatley, the value of timber inventory data for planning...

33 CFR 137.75 - The relationship of the purchase price to the value of the facility and the real property on...

Code of Federal Regulations, 2011 CFR

2011-07-01

... COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) MARINE POLLUTION FINANCIAL RESPONSIBILITY AND...-OWNER DEFENSE Standards and Practices § 137.75 The relationship of the purchase price to the value of...

33 CFR 137.75 - The relationship of the purchase price to the value of the facility and the real property on...

Code of Federal Regulations, 2014 CFR

2014-07-01

... COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) MARINE POLLUTION FINANCIAL RESPONSIBILITY AND...-OWNER DEFENSE Standards and Practices § 137.75 The relationship of the purchase price to the value of...

33 CFR 137.75 - The relationship of the purchase price to the value of the facility and the real property on...

Code of Federal Regulations, 2012 CFR

2012-07-01

... COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) MARINE POLLUTION FINANCIAL RESPONSIBILITY AND...-OWNER DEFENSE Standards and Practices § 137.75 The relationship of the purchase price to the value of...

33 CFR 137.75 - The relationship of the purchase price to the value of the facility and the real property on...

Code of Federal Regulations, 2010 CFR

2010-07-01

... COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) MARINE POLLUTION FINANCIAL RESPONSIBILITY AND...-OWNER DEFENSE Standards and Practices § 137.75 The relationship of the purchase price to the value of...

33 CFR 137.75 - The relationship of the purchase price to the value of the facility and the real property on...

Code of Federal Regulations, 2013 CFR

2013-07-01

... COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) MARINE POLLUTION FINANCIAL RESPONSIBILITY AND...-OWNER DEFENSE Standards and Practices § 137.75 The relationship of the purchase price to the value of...

Expect the unexpected: place-based protections can lead to unforeseen benefits

Treesearch

Rebecca L. Flitcroft; Daniel L. Bottom; Karen L. Haberman; Ken F. Bierly; Kim K. Jones; Charles A. Simenstad; Ayesha Gray; Kami S. Ellingson; Erin Baumgartner; Trevan J. Cornwell; Lance A. Campbell

2016-01-01

1. Protection of places important for aesthetic, ecological, and cultural values has been a goal of conservationists for over 150 years. Cornerstones of place-based conservation include legal designations, international agreements, and purchase by public or non-profit organizations.2. In the Salmon River catchment, Oregon, protections were initially...

48 CFR 201.603-2 - Selection.

Code of Federal Regulations, 2012 CFR

2012-10-01

... the following disciplines: accounting, business finance, law, contracts, purchasing, economics... additional requirements, based on the dollar value and complexity of the contracts awarded or administered in... appointed to a 3-year developmental position. Information on developmental opportunities is contained in DoD...

48 CFR 201.603-2 - Selection.

Code of Federal Regulations, 2011 CFR

2011-10-01

... the following disciplines: accounting, business finance, law, contracts, purchasing, economics... additional requirements, based on the dollar value and complexity of the contracts awarded or administered in... appointed to a 3-year developmental position. Information on developmental opportunities is contained in DoD...

48 CFR 201.603-2 - Selection.

Code of Federal Regulations, 2014 CFR

2014-10-01

... the following disciplines: accounting, business finance, law, contracts, purchasing, economics... additional requirements, based on the dollar value and complexity of the contracts awarded or administered in... appointed to a 3-year developmental position. Information on developmental opportunities is contained in DoD...

48 CFR 201.603-2 - Selection.

Code of Federal Regulations, 2013 CFR

2013-10-01

... the following disciplines: accounting, business finance, law, contracts, purchasing, economics... additional requirements, based on the dollar value and complexity of the contracts awarded or administered in... appointed to a 3-year developmental position. Information on developmental opportunities is contained in DoD...

The effects of price and perceived quality on the behavioural economics of alcohol, amphetamine, cannabis, cocaine, and ecstasy purchases.

PubMed

Goudie, Andrew J; Sumnall, Harry R; Field, Matt; Clayton, Hannah; Cole, Jon C

2007-07-10

Behavioural economic models of substance use describe the relationship between changes in unit price and consumption. However, these models rarely take account of the perceived quality (i.e. potency) of controlled drugs. Therefore we investigated the effects of both price and quality on the decision to purchase controlled drugs by polysubstance misusers. Forty current polysubstance misusers (29 males, 11 females; mean age 23.8) were recruited into the study. Participants were asked to hypothetically purchase drugs from a price list of alcohol, amphetamine, cannabis, cocaine and ecstasy at different levels of quality and price (i.e. better quality drugs cost more money). The disposable income available for those purchases was systematically varied in order to determine the impact of income on the decision to purchase drugs. Demand for both normal and strong alcohol was income inelastic. Demand for both poor and average quality cannabis and ecstasy was income inelastic, but demand for good quality cannabis and ecstasy was income elastic. The demand for poor quality cocaine was income inelastic, with the demand for both average and good quality cocaine being income elastic. Participants reported too few purchases of amphetamine, which precluded behavioural economic analysis. These results suggest that, like other goods, controlled drugs are purchased based upon the consumer's interpretations of their relative value. Therefore, it is probable that the purchase and subsequent use of controlled drugs by polysubstance misusers will be heavily influenced by the economic environment.

36 CFR 1207.31 - Real property.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Section 1207.31 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION GENERAL... original purchase to the fair market value of the property. However, in those situations where a grantee or... purchase of the real property to the current fair market value of the property. ...

Value-based purchasing of medical devices.

PubMed

Obremskey, William T; Dail, Teresa; Jahangir, A Alex

2012-04-01

Health care in the United States is known for its continued innovation and production of new devices and techniques. While the intention of these devices is to improve the delivery and outcome of patient care, they do not always achieve this goal. As new technologies enter the market, hospitals and physicians must determine which of these new devices to incorporate into practice, and it is important these devices bring value to patient care. We provide a model of a physician-engaged process to decrease cost and increase review of physician preference items. We describe the challenges, implementation, and outcomes of cost reduction and product stabilization of a value-based process for purchasing medical devices at a major academic medical center. We implemented a physician-driven committee that standardized and utilized evidence-based, clinically sound, and financially responsible methods for introducing or consolidating new supplies, devices, and technology for patient care. This committee worked with institutional finance and administrative leaders to accomplish its goals. Utilizing this physician-driven committee, we provided access to new products, standardized some products, decreased costs of physician preference items 11% to 26% across service lines, and achieved savings of greater than $8 million per year. The implementation of a facility-based technology assessment committee that critically evaluates new technology can decrease hospital costs on implants and standardize some product lines.

Effects of a price increase on purchases of sugar sweetened beverages. Results from a randomized controlled trial.

PubMed

Waterlander, Wilma Elzeline; Ni Mhurchu, Cliona; Steenhuis, Ingrid H M

2014-07-01

Sugar sweetened beverage (SSB) taxes are receiving increased political interest. However, there have been no experimental studies of the effects of price increases on SSBs or the effects on close substitutes such as diet drinks, alcohol or sugary snacks. Therefore, the aim of this study was to examine the effects of a price increase on SSBs on beverage and snack purchases using a randomized controlled design within a three-dimensional web-based supermarket. The trial contained two conditions: experimental condition with a 19% tax on SSBs (to reflect an increase in Dutch value added tax from 6% to 19%); and a control condition with regular prices. N = 102 participants were randomized and purchased groceries on a single occasion at a three-dimensional Virtual Supermarket. Data were analysed using independent t-tests and regression analysis. Results showed that participants in the price increase condition purchased significantly less SSBs than the control group (B = -.90; 95% CI = -1.70 to -.10 L per household per week). There were no significant effects on purchases in other beverage or snack food categories. This means that the higher VAT rate was effective in reducing SSB purchases and had no negative side-effects. Copyright © 2014. Published by Elsevier Ltd.

78 FR 28467 - Regulations Enabling Elections for Certain Transactions Under Section 336(e)

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-15

... purchase new target stock from unrelated new target shareholders with cash equal to the fair market value... deemed distribution of new target stock and purchaser will have a fair market value basis in new target... percent of the voting power and value of the stock of a corporation (target) as a sale of all its...

12 CFR 703.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... an investment to a counterparty at a price above its current fair value and simultaneously purchasing or committing to purchase from the counterparty another investment at a price above its current fair... Obligation means a class of a collateralized mortgage obligation (CMO) that, at the time of purchase...

The manager and equipment decisions: the capital budget.

PubMed

McConnell, Charles R

2011-01-01

As part of his or her role in preparing a departmental budget, a manager must often become involved in budgeting for capital expenditures, those purchases that are of a type and sufficient dollar value to be capitalized and depreciated. Depending on the value of a proposed purchase, the department manager may have only a partial voice in the process; some significant purchases will require administrative approval, whereas some major acquisitions will require approval by the board of directors. Planning for possible capital purchases should begin well before the start of the annual budget exercise. Listing a capital item in the department's budget request does not imply approval; often, there are many more "needs" than there are capital funds available. Therefore, there must be a consistent process for identifying the proposed purchases that will be funded, such process necessarily including detailed specification of the need for a particular capital purchase, identification of all reasonable alternatives, consideration of any constraints, detailed financial comparison of alternatives, assessment of intangible factors, and a recommended choice.

76 FR 39006 - Medicare Program; Hospital Inpatient Value-Based Purchasing Program; Correction

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-05

... Pneumonia (PN) 30-Day .8818 Mortality Rate. 7. On page 26516, Table 7 is corrected to read as follows... Day Mortality Rate. MORT-30 PN Pneumonia (PN) 30-Day .9021 Mortality Rate. 8. On page 26527, in the...

Influence of information about specific absorption rate (SAR) upon customers' purchase decisions and safety evaluation of mobile phones.

PubMed

Wiedemann, Peter M; Schütz, Holger; Clauberg, Martin

2008-02-01

This study investigated whether the SAR value is a purchase-relevant characteristic of mobile phones for laypersons and what effect the disclosure of a precautionary SAR value has on laypersons' risk perception. The study consisted of two parts: Study part 1 used a conjoint analysis design to explore the relevance of the SAR value and other features of mobile phones for an intended buying decision. Study part 2 used an experimental, repeated measures design to examine the effect of the magnitude of SAR values and the disclosure of a precautionary SAR value on risk perception. In addition, the study included an analysis of prior concerns of the study participants with regard to mobile phone risks. Part 1 indicates that the SAR value has a high relevance for laypersons' purchase intentions. In the experimental purchase setting it ranks even before price and equipment features. The results of study part 2 show that providing information of a precautionary limit value does not influence risk perception. This result suggests that laypersons' underlying subjective "safety model" for mobile phones resembles more a "margin of safety" concept than a threshold concept. The latter observation holds true no matter how concerned the participants are. (c) 2007 Wiley-Liss, Inc.

Serological diagnosis of bovine neosporosis: a Bayesian evaluation of two antibody ELISA tests for in vivo diagnosis in purchased and abortion cattle.

PubMed

Roelandt, S; Van der Stede, Y; Czaplicki, G; Van Loo, H; Van Driessche, E; Dewulf, J; Hooyberghs, J; Faes, C

2015-06-06

Currently, there are no perfect reference tests for the in vivo detection of Neospora caninum infection. Two commercial N caninum ELISA tests are currently used in Belgium for bovine sera (TEST A and TEST B). The goal of this study is to evaluate these tests used at their current cut-offs, with a no gold standard approach, for the test purpose of (1) demonstration of freedom of infection at purchase and (2) diagnosis in aborting cattle. Sera of two study populations, Abortion population (n=196) and Purchase population (n=514), were selected and tested with both ELISA's. Test results were entered in a Bayesian model with informative priors on population prevalences only (Scenario 1). As sensitivity analysis, two more models were used: one with informative priors on test diagnostic accuracy (Scenario 2) and one with all priors uninformative (Scenario 3). The accuracy parameters were estimated from the first model: diagnostic sensitivity (Test A: 93.54 per cent-Test B: 86.99 per cent) and specificity (Test A: 90.22 per cent-Test B: 90.15 per cent) were high and comparable (Bayesian P values >0.05). Based on predictive values in the two study populations, both tests were fit for purpose, despite an expected false negative fraction of ±0.5 per cent in the Purchase population and ±5 per cent in the Abortion population. In addition, a false positive fraction of ±3 per cent in the overall Purchase population and ±4 per cent in the overall Abortion population was found. British Veterinary Association.

26 CFR 1.1502-94 - Coordination with section 382 and the regulations thereunder when a corporation becomes a member...

Code of Federal Regulations, 2010 CFR

2010-04-01

....1502-91(d)(1). The testing period for L commences on August 1, Year 4. C's purchase of all the P stock... based on the value of the P stock immediately before the ownership change limits the amount of... allocation of income and loss). (2) Adjustment to value. Appropriate adjustments must be made to the extent...

The imperative of culture: a quantitative analysis of the impact of culture on workforce engagement, patient experience, physician engagement, value-based purchasing, and turnover.

PubMed

Owens, Katie; Eggers, Jim; Keller, Stephanie; McDonald, Audrey

2017-01-01

Current uncertainty for the future of the health care landscape is placing an increasing amount of pressure on leadership teams to be prepared to steer their organization forward in a number of potential directions. It is commonly recognized among health care leaders that culture will either enable or disable organizational success. However, very few studies empirically link culture to health care-specific performance outcomes. Nearly every health care organization in the US specifies its cultural aspirations through mission and vision statements and values. Ambitions of patient-centeredness, care for the community, workplace of choice, and world-class quality are frequently cited; yet, little definitive research exists to quantify the importance of building high-performing cultures. Our study examined the impact of cultural attributes defined by a culture index (Cronbach's alpha = 0.88) on corresponding performance with key health care measures. We mapped results of the culture index across data sets, compared results, and evaluated variations in performance among key indicators for leaders. Organizations that perform in the top quartile for our culture index statistically significantly outperformed those in the bottom quartile on all but one key performance indicator tested. The culture top quartile organizations outperformed every domain for employee engagement, physician engagement, patient experience, and overall value-based purchasing performance with statistical significance. Culture index top quartile performers also had a 3.4% lower turnover rate than the bottom quartile performers. Finally, culture index top quartile performers earned an additional 1% on value-based purchasing. Our findings demonstrate a meaningful connection between performance in the culture index and organizational performance. To best impact these key performance outcomes, health care leaders should pay attention to culture and actively steer workforce engagement in attributes that represent the culture index, such as treating patients as valued customers, having congruency between employee and organizational values, promoting employee pride, and encouraging the feeling that being a member of the organization is rewarding, in order to leverage culture as a competitive advantage.

The imperative of culture: a quantitative analysis of the impact of culture on workforce engagement, patient experience, physician engagement, value-based purchasing, and turnover

PubMed Central

Owens, Katie; Eggers, Jim; Keller, Stephanie; McDonald, Audrey

2017-01-01

Current uncertainty for the future of the health care landscape is placing an increasing amount of pressure on leadership teams to be prepared to steer their organization forward in a number of potential directions. It is commonly recognized among health care leaders that culture will either enable or disable organizational success. However, very few studies empirically link culture to health care-specific performance outcomes. Nearly every health care organization in the US specifies its cultural aspirations through mission and vision statements and values. Ambitions of patient-centeredness, care for the community, workplace of choice, and world-class quality are frequently cited; yet, little definitive research exists to quantify the importance of building high-performing cultures. Our study examined the impact of cultural attributes defined by a culture index (Cronbach’s alpha = 0.88) on corresponding performance with key health care measures. We mapped results of the culture index across data sets, compared results, and evaluated variations in performance among key indicators for leaders. Organizations that perform in the top quartile for our culture index statistically significantly outperformed those in the bottom quartile on all but one key performance indicator tested. The culture top quartile organizations outperformed every domain for employee engagement, physician engagement, patient experience, and overall value-based purchasing performance with statistical significance. Culture index top quartile performers also had a 3.4% lower turnover rate than the bottom quartile performers. Finally, culture index top quartile performers earned an additional 1% on value-based purchasing. Our findings demonstrate a meaningful connection between performance in the culture index and organizational performance. To best impact these key performance outcomes, health care leaders should pay attention to culture and actively steer workforce engagement in attributes that represent the culture index, such as treating patients as valued customers, having congruency between employee and organizational values, promoting employee pride, and encouraging the feeling that being a member of the organization is rewarding, in order to leverage culture as a competitive advantage. PMID:29355220

Evaluating and Optimizing Online Advertising: Forget the Click, but There Are Good Proxies.

PubMed

Dalessandro, Brian; Hook, Rod; Perlich, Claudia; Provost, Foster

2015-06-01

Online systems promise to improve advertisement targeting via the massive and detailed data available. However, there often is too few data on exactly the outcome of interest, such as purchases, for accurate campaign evaluation and optimization (due to low conversion rates, cold start periods, lack of instrumentation of offline purchases, and long purchase cycles). This paper presents a detailed treatment of proxy modeling, which is based on the identification of a suitable alternative (proxy) target variable when data on the true objective is in short supply (or even completely nonexistent). The paper has a two-fold contribution. First, the potential of proxy modeling is demonstrated clearly, based on a massive-scale experiment across 58 real online advertising campaigns. Second, we assess the value of different specific proxies for evaluating and optimizing online display advertising, showing striking results. The results include bad news and good news. The most commonly cited and used proxy is a click on an ad. The bad news is that across a large number of campaigns, clicks are not good proxies for evaluation or for optimization: clickers do not resemble buyers. The good news is that an alternative sort of proxy performs remarkably well: observed visits to the brand's website. Specifically, predictive models built based on brand site visits-which are much more common than purchases-do a remarkably good job of predicting which browsers will make a purchase. The practical bottom line: evaluating and optimizing campaigns using clicks seems wrongheaded; however, there is an easy and attractive alternative-use a well-chosen site-visit proxy instead.

25 CFR 700.183 - Determination of replacement housing benefit.

Code of Federal Regulations, 2010 CFR

2010-04-01

...; (1) The amount of the fair market value of the habitation and improvements purchased from an eligible... dwelling is less than the fair market value of the habitation and improvements purchased from an eligible... Four Family Dwelling Units). (2) The most recent Boecht Building Cost Modifier. (3) The experience of...

Enhancing the IT Infrastructure at Saint Philip's Hospital: Point-of-Care Solutions

ERIC Educational Resources Information Center

Naydenova, Iva; White, Bruce

2013-01-01

Healthcare has become a rapidly changing field. With the introduction of value-based purchasing to determine reimbursement of Medicare providers based on the quality of care in addition to outcomes in treatment, the environment is becoming ever more competitive. Saint Philip's Hospital is among the largest non-profit hospitals in the nation…

Observations from Laboratory and Field-based Evaluations of Select Low Cost Sensor Performance

EPA Science Inventory

• Produces data of known value and highly reliable• Stationary- cannot be easily relocated• Instruments are often large and require a building to support their operation• Expensive to purchase and operate (typically > $20K each)• Requires frequent visi...

36 CFR 223.62 - Timber purchaser road construction credit.

Code of Federal Regulations, 2010 CFR

2010-07-01

... deposits for slash disposal and road maintenance. As used in this section estimated construction costs... 36 Parks, Forests, and Public Property 2 2010-07-01 2010-07-01 false Timber purchaser road... § 223.62 Timber purchaser road construction credit. Appraisal may also establish stumpage value as if...

7 CFR 4284.924 - Ineligible uses of grant and matching funds.

Code of Federal Regulations, 2013 CFR

2013-01-01

... or facility (including a processing facility); (d) Purchase, lease purchase, or install fixed equipment, including processing equipment; (e) Purchase or repair vehicles, including boats; (f) Pay for the... processing and marketing of the value-added product; (h) Fund research and development; (i) Fund political or...

7 CFR 4284.924 - Ineligible uses of grant and matching funds.

Code of Federal Regulations, 2014 CFR

2014-01-01

... or facility (including a processing facility); (d) Purchase, lease purchase, or install fixed equipment, including processing equipment; (e) Purchase or repair vehicles, including boats; (f) Pay for the... processing and marketing of the value-added product; (h) Fund research and development; (i) Fund political or...

7 CFR 4284.924 - Ineligible uses of grant and matching funds.

Code of Federal Regulations, 2012 CFR

2012-01-01

... or facility (including a processing facility); (d) Purchase, lease purchase, or install fixed equipment, including processing equipment; (e) Purchase or repair vehicles, including boats; (f) Pay for the... processing and marketing of the value-added product; (h) Fund research and development; (i) Fund political or...

43 CFR 5461.2 - Required payment schedule.

Code of Federal Regulations, 2013 CFR

2013-10-01

... officer signs the contract. A purchaser cannot apply any portion of the first installment to cover other payments due on the contract until either 60 percent of the total purchase price has been paid or road... of the total purchase price. The value of satisfactorily completed road construction required by the...

43 CFR 5461.2 - Required payment schedule.

Code of Federal Regulations, 2011 CFR

2011-10-01

... officer signs the contract. A purchaser cannot apply any portion of the first installment to cover other payments due on the contract until either 60 percent of the total purchase price has been paid or road... of the total purchase price. The value of satisfactorily completed road construction required by the...

43 CFR 5461.2 - Required payment schedule.

Code of Federal Regulations, 2012 CFR

2012-10-01

... officer signs the contract. A purchaser cannot apply any portion of the first installment to cover other payments due on the contract until either 60 percent of the total purchase price has been paid or road... of the total purchase price. The value of satisfactorily completed road construction required by the...

43 CFR 5461.2 - Required payment schedule.

Code of Federal Regulations, 2014 CFR

2014-10-01

... officer signs the contract. A purchaser cannot apply any portion of the first installment to cover other payments due on the contract until either 60 percent of the total purchase price has been paid or road... of the total purchase price. The value of satisfactorily completed road construction required by the...

Theory of health insurance.

PubMed

Nyman, J A

1998-01-01

The conventional explanation for purchasing insurance is to transfer risk. Psychologists, however, have shown that this explanation does not match actual behavior. They find that people generally prefer the risk of no loss at all to the certainty of a smaller actuarially equivalent loss, a situation exactly opposite to the one represented by the purchase of insurance. Nevertheless, people do purchase insurance, so there must be an explanation other than risk transfer for purchasing it. Of the explanations so far advanced, however, none have yet developed a wide acceptance. Regardless of risk issues, people will be more likely to purchase insurance when the premium is low compared to the value of the coverage to the consumer. Moral hazard raises the premium, as does adverse selection. The presence of either makes the purchase of insurance less likely. With health insurance, the tax subsidy can reduce the effective premium to less than the actuarially fair cost of insurance. This would increase the likelihood that health insurance is purchased. Finally, because of the value we place on our health, we desire access to a full range of health care. Health insurance is often the only affordable way of gaining access to this care, given the high costs of many of these procedures.

31 CFR 360.10 - Amounts which may be purchased.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance:Treasury 2 2011-07-01 2011-07-01 false Amounts which may be purchased. 360.10 Section 360.10 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL... follows: (a) General annual limitation, $5,000 (par value). (b) Special limitation, $4,000 (par value...

31 CFR 360.10 - Amounts which may be purchased.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance:Treasury 2 2012-07-01 2012-07-01 false Amounts which may be purchased. 360.10 Section 360.10 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL... follows: (a) General annual limitation, $5,000 (par value). (b) Special limitation, $4,000 (par value...

Validation of the Consumer Values versus Perceived Product Attributes Model Measuring the Purchase of Athletic Team Merchandise

ERIC Educational Resources Information Center

Lee, Donghun; Byon, Kevin K.; Schoenstedt, Linda; Johns, Gary; Bussell, Leigh Ann; Choi, Hwansuk

2012-01-01

Various consumer values and perceived product attributes trigger consumptive behaviors of athletic team merchandise (Lee, Trail, Kwon, & Anderson, 2011). Likewise, using a principal component analysis technique on a student sample, a measurement scale was proposed that consisted of nine factors affecting the purchase of athletic team…

47 CFR 54.513 - Resale and transfer of services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... subpart shall not be sold, resold, or transferred in consideration of money or any other thing of value... over the Internet. There is no prohibition on the resale of services that are not purchased pursuant to... of money or any other thing of value, for a period of three years after purchase, except that...

24 CFR 970.11 - Procedures for the offer of sale to established eligible organizations.

Code of Federal Regulations, 2010 CFR

2010-04-01

... purchase the property; (d) Contents of initial written notification. The initial written notification to... opportunity to purchase the development, the development's value, and potential use; (5) A statement that... to purchase the property and to obtain a firm financial commitment, as defined in § 970.5. The...

Analyzing The Impacts of the Biogas-to-Electricity Purchase Incentives on Electric Vehicle Deployment with the MA3T Vehicle Choice Model

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

Podkaminer, Kara; Xie, Fei; Lin, Zhenhong

This analysis represents the biogas-to-electricity pathway under the Renewable Fuel Standard (RFS) as a point of purchase incentive and tests the impact of this incentive on EV deployment using a vehicle consumer choice model. The credit value generated under this policy was calculated in a number of scenarios based on electricity use of each power train choice on a yearly basis over the 15 year vehicle lifetime, accounting for the average electric vehicle miles travelled and vehicle efficiency, competition for biogas-derived electricity among electric vehicles (EVs), the RIN equivalence value and the time value of money. The credit value calculationmore » in each of these scenarios is offered upfront as a point of purchase incentive for EVs using the Market Acceptance of Advanced Automotive Technologies (MA3T) vehicle choice model, which tracks sales, fleet size and energy use over time. The majority of the scenarios use a proposed RIN equivalence value, which increases the credit value as a way to explore the analysis space. Additional model runs show the relative impact of the equivalence value on EV deployment. The MA3T model output shows that a consumer incentive accelerates the deployment of EVs for all scenarios relative to the baseline (no policy) case. In the scenario modeled to represent the current biogas-to-electricity generation capacity (15 TWh/year) with a 5.24kWh/RIN equivalence value, the policy leads to an additional 1.4 million plug-in hybrid electric vehicles (PHEVs) and 3.5 million battery electric vehicles (BEVs) in 2025 beyond the no-policy case of 1.3 million PHEVs and 2.1 million BEVs when the full value of the credit is passed on to the consumer. In 2030, this increases to 2.4 million PHEVs and 7.3 million BEVs beyond the baseline. This larger impact on BEVs relative to PHEVs is due in part to the larger credit that BEVs receive in the model based on the greater percentage of electric vehicle miles traveled by BEVs relative to PHEVs. In this scenario 2025 also represents the last year in which biogas-derived electricity is able to fully supply the transportation electricity demand in the model. After 2025, the credit value declines on a per vehicle basis. At the same time a larger fraction of the credit may shift towards biogas producers in order to incent additional biogas production. The expanded 41 TWh/year biogas availability scenarios represent an increase beyond today s generation capacity and allow greater eRIN generation. With a 5.24kWh/RIN equivalence value, when all of the credit is directed towards reducing vehicle purchase prices, the 41 TWh/year biogas scenario results in 4.1 million additional PHEVs and 12.2 million additional BEVs on the road in 2030 beyond the baseline of 2.5 million PHEVs and 6.1 million BEVs. Under this expanded biogas capacity, biogas-derived electricity generation is able to fully supply electricity for a fleet of over 21 million EVs (15.6 million BEVs and 5.8 million PHEVs) on a yearly basis. In addition to assessing the full value credit scenarios described above, multiple scenarios were analyzed to determine the impact if only a fraction of the credit value was passed on to the consumer. In all of these cases, the EV deployment was scaled back as the fraction of the credit that was passed on to the consumer was reduced. These scenarios can be used to estimate the impact if the credit value is reduced in other ways as well, as demonstrated by the scenarios where the current (22.6 kWh/RIN) equivalence value was used. The EV deployment that results from an equivalence value of 22.6 kWh/RIN equivalence value is roughly equivalent to the EV deployment observed in the 25% case using the 5.24 kWh/RIN equivalence value. A higher equivalence value means that a smaller number of credits, and therefore value, is created for each kWh, and therefore the impact on EV deployment is reduced. This analysis shows several of the drivers that will impact eRIN generation and credit value, and tests the impact of an eRIN point of purchase incentive on EV deployment. This additional incentive can accelerate the deployment of EVs when it is used to reduce vehicle purchase prices. However, the ultimate impact of this policy, as modeled here, will be determined by future RIN prices, the extent to which eRIN credit value can be passed on to the consumer as a point of purchase incentive and the equivalence value.« less

A natural value unit—Econophysics as arbiter between finance and economics

NASA Astrophysics Data System (ADS)

Defilla, Steivan

2007-08-01

Foreign exchange markets show that currency units ( = accounting or nominal price units) are variables. Technical and economic progress evidences that the consumer baskets ( = purchasing power units or real price units) are also variables. In contrast, all physical measurement units are constants and either defined in the SI (=metric) convention or based upon natural constants ( = “natural” or Planck units). Econophysics can identify a constant natural value scale or value unit (natural numeraire) based upon Planck energy. In honor of the economist L. Walras, this “Planck value” could be called Walras (Wal), thereby using the SI naming convention. One Wal can be shown to have a physiological and an economic interpretation in that it is equal to the annual minimal real cost of physiological life of a reference person at minimal activity. The price of one Wal in terms of any currency can be estimated by hedonic regression techniques used in inflation measurement (axiometry). This pilot research uses official disaggregated Swiss Producer and Consumer Price Index (PPI and CPI) data and estimates the hedonic Walras price (HWP), quoted in Swiss francs in 2003, and its inverse, the physical purchasing power (PhPP) of the Swiss franc in 2003.

5 CFR 180.108 - Settlement of claims.

Code of Federal Regulations, 2010 CFR

2010-01-01

... purchase or exchange. The amount payable will be determined by applying the principles of depreciation to the adjusted dollar value or other base price of property lost or damaged beyond economical repair; by... cost, condition when damaged beyond economical repair or lost, and the time elapsed between the date of...

A Theoretical Model of Team-Licensed Merchandise Purchasing (TLMP)

ERIC Educational Resources Information Center

Lee, Donghun; Trail, Galen

2011-01-01

Although it is evident that sales of team licensed merchandise (TLM) contribute to the overall consumption of sport, research efforts that comprehensively describe what triggers the consumption of TLM is lacking (Lee, Trail, Kwon, & Anderson, 2011). Therefore, based on multiple theories (i.e., values theory, identity theory, attitude theory, and…

Accounting issues: should the merger be treated as purchase or pooling?

PubMed

Finkler, S A

1985-05-01

Under accounting rules, a merger or consolidation can be treated as either a purchase or pooling. A purchase causes an adjustment in the selling hospital's asset basis to fair market value with goodwill often resulting. Such an adjustment is usually favorable for a taxable acquisition but not a tax-free reorganization. A pooling, on the other hand, results in the assets of the two organizations being merged together with no adjustment in asset values or increase in goodwill. The requirements for pooling are strict but the result is the carryover of assets at historical cost, usually favorable for reporting EPS.

Pathways for Off-site Corporate PV Procurement

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

Heeter, Jenny S

Through July 2017, corporate customers contracted for more than 2,300 MW of utility-scale solar. This paper examines the benefits, challenges, and outlooks for large-scale off-site solar purchasing through four pathways: power purchase agreements, retail choice, utility partnerships (green tariffs and bilateral contracts with utilities), and by becoming a licensed wholesale seller of electricity. Each pathway differs based on where in the United States it is available, the value provided to a corporate off-taker, and the ease of implementation. The paper concludes with a discussion of future pathway comparison, noting that to deploy more corporate off-site solar, new procurement pathways aremore » needed.« less

The value of group purchasing organizations in the United States.

PubMed

Rooney, Curtis

2011-01-01

This article examines the valuable role of group purchasing organizations (GPOs) in hospital purchasing in the United States. For over 100 years old GPOs have helped hospitals and other health care providers realize savings and create contracting efficiencies by aggregating purchasing volume to negotiate discounts with manufacturers, distributors and other vendors. The US has recently enacted a series of healthcare reforms to correct some of the historical concerns regarding cost, quality and access. GPOs are expected to continue to play a critical role in the business of hospital purchasing and may potential export that other countries may wish to examine.

77 FR 3292 - Main Street Capital Corporation, et al.; Notice of Application

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-23

... of the Company at the time of the Purchases, shareholders of the Company will not experience dilution... Company to purchase equity interests in Main Street Capital II, LP (``MSC'') from certain persons who are.... Since the Exchange Offer, the Company has purchased an additional 0.5% of the total dollar value of...

Relationships between consumption of alcoholic beverages and healthy foods: the French supermarket cohort of 196,000 subjects.

PubMed

Hansel, Boris; Roussel, Ronan; Diguet, Vincent; Deplaude, Amandine; Chapman, M John; Bruckert, Eric

2015-02-01

Moderate alcohol consumption is associated with reduced risk of cardiovascular disease. Related dietary habits and lifestyle may bias assessment of the relationship between alcohol intake and health status. We examined the relationship between key features relating to the consumption of alcoholic beverages and individual profiles of objective food purchases. Data were collected on regular clients of a large supermarket chain implanted across France (n = 196,604). Food items purchased were classified into three categories: (1) healthy foods; (2) unhealthy foods; and (3) others. Wine consumers favoured purchase of healthy foods more often than others, whereas the lowest level of healthy food purchasers was associated with consumption of beer and aniseed-based beverages. Bordeaux wine purchasers spent less in their average budget than the whole population for nine out of the 11 unhealthy food categories. Conversely, the budget was markedly higher in non-alcohol purchasers as compared to the whole population for seven out of the 11 unhealthy foods. The ratio of the budget for healthy to that for unhealthy foods was also distinct between the groups, being highest for wine and lowest for beer. In the subgroup of non-alcohol consumers, this ratio was intermediate but significantly lower relative to values in the five subcategories of wine purchasers. Marked differences in the profile of the purchase of healthy versus unhealthy food products as a function of the subcategory of alcoholic beverage consumed were documented, revealing a critical unidentified confounding feature in analyses of the potential relationship between alcohol consumption and protection against cardiovascular disease. © The European Society of Cardiology 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Priority setting and evidence based purchasing.

PubMed

Frith, L

1999-01-01

The purpose of this paper is to consider the role that values play in priority setting through the use of EBP. It is important to be clear about the role of values at all levels of the decision making process. At one level, society as a whole has to make decisions about the kind of health provision that it wants. As is generally accepted, these priority setting questions cannot be answered by medical science alone but involve important judgements of value. However, as I hope to show values come into priority setting questions at another level, one not often explicitly recognised in much of the literature: that of the very definition of the effectiveness of treatments. This has important consequences for patient care. If we do not recognise that the effectiveness of a treatment involve subjective elements--a patient's own assessment of the value of the treatment--then this could lead to the belief that we can purchase one treatment that is the most effective for all patients. This might result in a detrimental reduction in the range of options that a patient is given with some patients not receiving the treatment that is most effective for them.

17 CFR 240.15c3-1d - Satisfactory Subordination Agreements (Appendix D to 17 CFR 240.15c3-1).

Code of Federal Regulations, 2010 CFR

2010-04-01

... market value of commodity options purchased by option customers subject to the rules of a contract market, each such deduction not to exceed the amount of funds in the option customer's account), if greater. No... regulations thereunder (less the market value of commodity options purchased by option customers subject to...

Relying on Your Own Best Judgment: Imputing Values to Missing Information in Decision Making.

ERIC Educational Resources Information Center

Johnson, Richard D.; And Others

Processes involved in making estimates of the value of missing information that could help in a decision making process were studied. Hypothetical purchases of ground beef were selected for the study as such purchases have the desirable property of quantifying both the price and quality. A total of 150 students at the University of Iowa rated the…

Assessing the impact of a cattle risk-based trading scheme on the movement of bovine tuberculosis infected animals in England and Wales.

PubMed

Adkin, A; Brouwer, A; Downs, S H; Kelly, L

2016-01-01

The adoption of bovine tuberculosis (bTB) risk-based trading (RBT) schemes has the potential to reduce the risk of bTB spread. However, any scheme will have cost implications that need to be balanced against its likely success in reducing bTB. This paper describes the first stochastic quantitative model assessing the impact of the implementation of a cattle risk-based trading scheme to inform policy makers and contribute to cost-benefit analyses. A risk assessment for England and Wales was developed to estimate the number of infected cattle traded using historic movement data recorded between July 2010 and June 2011. Three scenarios were implemented: cattle traded with no RBT scheme in place, voluntary provision of the score and a compulsory, statutory scheme applying a bTB risk score to each farm. For each scenario, changes in trade were estimated due to provision of the risk score to potential purchasers. An estimated mean of 3981 bTB infected animals were sold to purchasers with no RBT scheme in place in one year, with 90% confidence the true value was between 2775 and 5288. This result is dependent on the estimated between herd prevalence used in the risk assessment which is uncertain. With the voluntary provision of the risk score by farmers, on average, 17% of movements was affected (purchaser did not wish to buy once the risk score was available), with a reduction of 23% in infected animals being purchased initially. The compulsory provision of the risk score in a statutory scheme resulted in an estimated mean change to 26% of movements, with a reduction of 37% in infected animals being purchased initially, increasing to a 53% reduction in infected movements from higher risk sellers (score 4 and 5). The estimated mean reduction in infected animals being purchased could be improved to 45% given a 10% reduction in risky purchase behaviour by farmers which may be achieved through education programmes, or to an estimated mean of 49% if a rule was implemented preventing farmers from the purchase of animals of higher risk than their own herd. Given voluntary trials currently taking place of a trading scheme, recommendations for future work include the monitoring of initial uptake and changes in the purchase patterns of farmers. Such data could be used to update the risk assessment to reduce uncertainty associated with model estimates. Crown Copyright © 2015. Published by Elsevier B.V. All rights reserved.

16 CFR 233.4 - Bargain offers based upon the purchase of other merchandise.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Bargain offers based upon the purchase of... PRACTICE RULES GUIDES AGAINST DECEPTIVE PRICING § 233.4 Bargain offers based upon the purchase of other... given a customer on the condition that he purchase a particular article at the price usually offered by...

The Value of Competitive Contracting

DTIC Science & Technology

2014-09-01

Research & Engineering) BBP Better Buying Power BOA basic ordering agreement BPA basic purchase agreement CAE Component Acquisition Executive CDSA...competitive procedures for the following contract actions:” a. Contract and purchase orders b. Orders and calls under part 13 Basic Purchase Agreement ( BPA ...Basic Ordering Agreement (BOA) c. Government wide acquisition contracts and IDIQ contracts d. BPAs and BPA calls under Federal Supply Schedules

43 CFR 30.271 - How must the tribe pay for the interests it purchases?

Code of Federal Regulations, 2010 CFR

2010-10-01

... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false How must the tribe pay for the interests it purchases? 30.271 Section 30.271 Public Lands: Interior Office of the Secretary of the Interior... the tribe pay for the interests it purchases? (a) A tribe must pay the full fair market value of the...

43 CFR 30.271 - How must the tribe pay for the interests it purchases?

Code of Federal Regulations, 2011 CFR

2011-10-01

... 43 Public Lands: Interior 1 2011-10-01 2011-10-01 false How must the tribe pay for the interests it purchases? 30.271 Section 30.271 Public Lands: Interior Office of the Secretary of the Interior... the tribe pay for the interests it purchases? (a) A tribe must pay the full fair market value of the...

UK consumer perceptions of a novel till-receipt 'traffic-light' nutrition system.

PubMed

Cole, Matthew; Peek, Hayden; Cowen, Daniel

2018-03-26

Front-of-pack (FoP) traffic light nutrition labelling has been widely proposed as a tool to improve public health nutrition. Current evidence suggests that whilst consumers generally find them to be useful and an important source of information about a particular food or ingredient, this may have limited value in isolation when considering a person's overall nutritional intake. This study sought to examine UK consumers' use of existing FoP traffic light food labelling and ascertain public perception of a novel 'till-receipt' summary providing nutritional information about consumers entire shopping purchases. In total, 237 respondents completed an online questionnaire between May and June 2016. Almost two-thirds were female (n = 152, 64.1%) and the largest proportion of responses were received from those aged 25-32 years (n = 53, 22.4%) and 41-50 years (n = 53, 22.4%). About 83.5% of respondents suggested that they currently use traffic light information to inform their food purchases and 'health' was reported as the most important factor influencing food choice (42.2%; n = 100). Notably, 54.4% of respondents indicated that the novel till-receipt system could provide a solution to the potential limitations of existing FoP labelling and could help inform healthier food purchases. Our findings strengthen the existing evidence base to suggest that traffic light information is a useful tool to aid consumer food purchases. Moreover, our outcomes propose that consumers may benefit from a new receipt-based traffic light system which provides a more holistic summary of their entire food purchases.

Essays in applied microeconomics

NASA Astrophysics Data System (ADS)

Davis, Lucas William

2005-11-01

The first essay measures the impact of an outbreak of pediatric leukemia on local housing values. A model of residential location choice is used to describe conditions under which the gradient of the hedonic price function with respect to health risk is equal to household marginal willingness to pay to avoid pediatric leukemia risk. This equalizing differential is estimated using property-level sales records from a county in Nevada where residents have recently experienced a severe increase in pediatric leukemia. Housing values are compared before and after the increase with a nearby county acting as a control group. The results indicate that housing values decreased 15.6% during the period of maximum risk. Results are similar for alternative measures of risk and across houses of different sizes. With risk estimates derived using a Bayesian learning model the results imply a statistical value of pediatric leukemia of $5.6 million. The results from the paper provide some of the first market-based estimates of the value of health for children. The second essay evaluates the cost-effectiveness of public incentives that encourage households to purchase high-efficiency durable goods. The demand for durable goods and the demand for energy and other inputs are modeled jointly as the solution to a household production problem. The empirical analysis focuses on the case of clothes washers. The production technology and utilization decision are estimated using household-level data from field trials in which participants received front-loading clothes washers free of charge. The estimation strategy exploits this quasi-random replacement of washers to derive robust estimates of the utilization decision. The results indicate a price elasticity, -.06, that is statistically different from zero across specifications. The parameters from the utilization decision are used to estimate the purchase decision using data from the Consumer Expenditure Survey, 1994-2002. Households consider optimal utilization levels, purchase prices, water rates, energy rates and other factors when deciding which clothes washer to purchase. The complete model is used to simulate the effects of rebate programs and other policies on adoption patterns of clothes washers and household demand for water and energy.

Understanding Patient Satisfaction Ratings for Radiology Services

PubMed Central

Lang, Elvira V.; Yuh, William T.C.; Kelly, Ronda; Macadam, Luke; Potts, Richard; Mayr, Nina A.

2015-01-01

Under the Hospital Value-Based Purchasing Program of the Centers for Medicare & Medicaid Services patient satisfaction accounts for 30% of the measures of and payments for quality of care. Understanding what drives satisfaction data, how it is obtained, converted into scores, and formulated into rankings, is increasingly critical for imaging departments. PMID:24261356

Behavioral Targeting—Consumer Tracking

NASA Astrophysics Data System (ADS)

Srimani, P. K.; Srinivas, A.

2011-12-01

Behavioral targeting is an online marketing method that collects data on the browsing activities of consumers, in order to `target' more relevant online advertising. Behavioral targeting enables marketers to reach in-market consumers and increases the value of publisher inventory. At the heart of behavioral targeting is a learning-based investigation of consumer behaviors. It helps marketers understand consumers' purchase patterns over time, mapping out a customer's activities based not only on a single purchase but also on an annual or even lifetime basis. As marketers increasingly appreciate the importance of customer lifetime value, behavioral targeting can be a foundation for creating a continuous analytical study of consumer trends and patterns. But as behavioural-targeting systems become more sophisticated and invasive, it is vital that the companies behind them are open with users about what is going on, and give them control over their personal information. The aim of this paper is to explore the various tools and techniques of behavioral targeting and its benefits to online marketing. A multiple—case study approach was used for exploring the effectiveness and acceptance of online marketing in the area of the online marketing.

Value-based formulas for purchasing. Does managed care offer value to society?

PubMed

Priester, R

1997-01-01

To assess whether managed care is, all things considered, a good investment for our society, we can measure its performance relative to five essential health care goals: promote efficiency; expand access; improve quality; preserve freedom of choice; and protect patient advocacy. These goals, which have shaped and continue to shape health care policy, define what is important to us in our health care system. Concerns about managed care's ability to advance these goals and thus to offer value are heightened if recently observed trends continue.

47 CFR 54.615 - Obtaining services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... provided under § 54.621, that the requester cannot obtain toll-free access to an Internet service provider... thing of value; (6) If the service or services are being purchased as part of an aggregated purchase...

Value-Based Emergency Management.

PubMed

Corrigan, Zachary; Winslow, Walter; Miramonti, Charlie; Stephens, Tim

2016-02-01

This article touches on the complex and decentralized network that is the US health care system and how important it is to include emergency management in this network. By aligning the overarching incentives of opposing health care organizations, emergency management can become resilient to up-and-coming changes in reimbursement, staffing, and network ownership. Coalitions must grasp the opportunity created by changes in value-based purchasing and impending Centers for Medicare and Medicaid Services emergency management rules to engage payers, physicians, and executives. Hope and faith in doing good is no longer enough for preparedness and health care coalitions; understanding how physicians are employed and health care is delivered and paid for is now necessary. Incentivizing preparedness through value-based compensation systems will become the new standard for emergency management.

The Accuracy of Stated Energy Contents of Reduced-Energy, Commercially Prepared Foods

PubMed Central

Urban, Lorien E.; Dallal, Gerard E.; Robinson, Lisa M.; Ausman, Lynne M.; Saltzman, Edward; Roberts, Susan B.

2010-01-01

The accuracy of stated energy contents of reduced-energy restaurant foods and frozen meals purchased from supermarkets was evaluated. Measured energy values of 29 quick-serve and sit-down restaurant foods averaged 18% more than stated values, and measured energy values of 10 frozen meals purchased from supermarkets averaged 8% more than originally stated. These differences substantially exceeded laboratory measurement error but did not achieve statistical significance due to considerable variability in the degree of underreporting. Some individual restaurant items contained up to 200% of stated values and, in addition, free side dishes increased provided energy to an average of 245% of stated values for the entrees they accompanied. These findings suggest that stated energy contents of reduced-energy meals obtained from restaurants and supermarkets are not consistently accurate, and in this study averaged more than measured values, especially when free side dishes were taken into account. If widespread, this phenomenon could hamper efforts to self-monitor energy intake to control weight, and could also reduce the potential benefit of recent policy initiatives to disseminate information on food energy content at the point of purchase. PMID:20102837

A roadmap for improving healthcare service quality.

PubMed

Kennedy, Denise M; Caselli, Richard J; Berry, Leonard L

2011-01-01

A data-driven, comprehensive model for improving service and creating long-term value was developed and implemented at Mayo Clinic Arizona (MCA). Healthcare organizations can use this model to prepare for value-based purchasing, a payment system in which quality and patient experience measures will influence reimbursement. Surviving and thriving in such a system will require a comprehensive approach to sustaining excellent service performance from physicians and allied health staff (e.g., nurses, technicians, nonclinical staff). The seven prongs in MCA's service quality improvement model are (1) multiple data sources to drive improvement, (2) accountability for service quality, (3) service consultation and improvement tools, (4) service values and behaviors, (5) education and training, (6) ongoing monitoring and control, and (7) recognition and reward. The model was fully implemented and tested in five departments in which patient perception of provider-specific service attributes and/or overall quality of care were below the 90th percentile for patient satisfaction in the vendor's database. Extent of the implementation was at the discretion of department leadership. Perception data rating various service attributes were collected from randomly selected patients and monitored over a 24-month period. The largest increases in patient perception of excellence over the pilot period were realized when all seven prongs of the model were implemented as a comprehensive improvement approach. The results of this pilot may help other healthcare organizations prepare for value-based purchasing.

If you build it, will they eat it? Consumer preferences for plant-based and cultured meat burgers.

PubMed

Slade, Peter

2018-06-01

In a hypothetical choice experiment consumers were given the option of purchasing burgers that were made from beef, plant-based protein, or cultured meat. Willingness to purchase plant-based and cultured meat burgers is linked to age, sex, views of other food technologies, and attitudes towards the environment and agriculture. Although consumers were told that all burgers tasted the same, there was a marked preference for beef burgers. A mixed-logit model predicts that, if prices were equal, 65% of consumers would purchase the beef burger, 21% would purchase the plant-based burger, 11% would purchase the cultured meat burger, and 4% would make no purchase. Preferences for plant-based and cultured meat burgers are found to be highly, but not perfectly, correlated. Copyright © 2018 Elsevier Ltd. All rights reserved.

Web-based Factors Affecting Online Purchasing Behaviour

NASA Astrophysics Data System (ADS)

Ariff, Mohd Shoki Md; Sze Yan, Ng; Zakuan, Norhayati; Zaidi Bahari, Ahamad; Jusoh, Ahmad

2013-06-01

The growing use of internet and online purchasing among young consumers in Malaysia provides a huge prospect in e-commerce market, specifically for B2C segment. In this market, if E-marketers know the web-based factors affecting online buyers' behaviour, and the effect of these factors on behaviour of online consumers, then they can develop their marketing strategies to convert potential customers into active one, while retaining existing online customers. Review of previous studies related to the online purchasing behaviour in B2C market has point out that the conceptualization and empirical validation of the online purchasing behaviour of Information and Communication Technology (ICT) literate users, or ICT professional, in Malaysia has not been clearly addressed. This paper focuses on (i) web-based factors which online buyers (ICT professional) keep in mind while shopping online; and (ii) the effect of web-based factors on online purchasing behaviour. Based on the extensive literature review, a conceptual framework of 24 items of five factors was constructed to determine web-based factors affecting online purchasing behaviour of ICT professional. Analysis of data was performed based on the 310 questionnaires, which were collected using a stratified random sampling method, from ICT undergraduate students in a public university in Malaysia. The Exploratory factor analysis performed showed that five factors affecting online purchase behaviour are Information Quality, Fulfilment/Reliability/Customer Service, Website Design, Quick and Details, and Privacy/Security. The result of Multiple Regression Analysis indicated that Information Quality, Quick and Details, and Privacy/Security affect positively online purchase behaviour. The results provide a usable model for measuring web-based factors affecting buyers' online purchase behaviour in B2C market, as well as for online shopping companies to focus on the factors that will increase customers' online purchase.

The Impact of Nursing Home Pay-for-Performance on Quality and Medicare Spending: Results from the Nursing Home Value-Based Purchasing Demonstration.

PubMed

Grabowski, David C; Stevenson, David G; Caudry, Daryl J; O'Malley, A James; Green, Lisa H; Doherty, Julia A; Frank, Richard G

2017-08-01

To evaluate the impact of the Nursing Home Value-Based Purchasing demonstration on quality of care and Medicare spending. Administrative and qualitative data from Arizona, New York, and Wisconsin nursing homes over the base-year (2008-2009) and 3-year (2009-2012) demonstration period. Nursing homes were randomized to the intervention in New York, while the comparison facilities were constructed via propensity score matching in Arizona and Wisconsin. We used a difference-in-difference analysis to compare outcomes across the base-year relative to outcomes in each of the three demonstration years. To provide context and assist with interpretation of results, we also interviewed staff members at participating facilities. Medicare savings were observed in Arizona in the first year only and Wisconsin for the first 2 years; no savings were observed in New York. The demonstration did not systematically impact any of the quality measures. Discussions with nursing home administrators suggested that facilities made few, if any, changes in response to the demonstration, leading us to conclude that the observed savings likely reflected regression to the mean rather than true savings. The Federal nursing home pay-for-performance demonstration had little impact on quality or Medicare spending. © Health Research and Educational Trust.

Analysis of cigarette purchase task instrument data with a left-censored mixed effects model.

PubMed

Liao, Wenjie; Luo, Xianghua; Le, Chap T; Chu, Haitao; Epstein, Leonard H; Yu, Jihnhee; Ahluwalia, Jasjit S; Thomas, Janet L

2013-04-01

The drug purchase task is a frequently used instrument for measuring the relative reinforcing efficacy (RRE) of a substance, a central concept in psychopharmacological research. Although a purchase task instrument, such as the cigarette purchase task (CPT), provides a comprehensive and inexpensive way to assess various aspects of a drug's RRE, the application of conventional statistical methods to data generated from such an instrument may not be adequate by simply ignoring or replacing the extra zeros or missing values in the data with arbitrary small consumption values, for example, 0.001. We applied the left-censored mixed effects model to CPT data from a smoking cessation study of college students and demonstrated its superiority over the existing methods with simulation studies. Theoretical implications of the findings, limitations of the proposed method, and future directions of research are also discussed.

Effects of disputes and easement violations on the cost-effectiveness of land conservation

PubMed Central

Arcese, Peter

2015-01-01

Conservation initiatives to protect and restore valued species communities in human-dominated landscapes face challenges linked to their potential costs. Conservation easements on private land may represent a cost-effective alternative to land purchase, but long-term costs to monitor and enforce easements, or defend legal challenges, remain uncertain. We explored the cost-effectiveness of conservation easements, defined here as the fraction of the high-biodiversity landscape potentially protected via investment in easements versus land purchase. We show that easement violation and dispute rates substantially affect the estimated long-term cost-effectiveness of an easement versus land purchase strategy. Our results suggest that conservation easements can outperform land purchase as a strategy to protect biodiversity as long as the rate of disputes and legal challenges is low, pointing to a critical need for monitoring data to reduce costs and maximize the value of conservation investments. PMID:26413430

Analysis of Cigarette Purchase Task Instrument Data with a Left-Censored Mixed Effects Model

PubMed Central

Liao, Wenjie; Luo, Xianghua; Le, Chap; Chu, Haitao; Epstein, Leonard H.; Yu, Jihnhee; Ahluwalia, Jasjit S.; Thomas, Janet L.

2015-01-01

The drug purchase task is a frequently used instrument for measuring the relative reinforcing efficacy (RRE) of a substance, a central concept in psychopharmacological research. While a purchase task instrument, such as the cigarette purchase task (CPT), provides a comprehensive and inexpensive way to assess various aspects of a drug’s RRE, the application of conventional statistical methods to data generated from such an instrument may not be adequate by simply ignoring or replacing the extra zeros or missing values in the data with arbitrary small consumption values, e.g. 0.001. We applied the left-censored mixed effects model to CPT data from a smoking cessation study of college students and demonstrated its superiority over the existing methods with simulation studies. Theoretical implications of the findings, limitations of the proposed method and future directions of research are also discussed. PMID:23356731

Availability and Use of Cheap Tobacco in the United Kingdom 2002-2014: Findings From the International Tobacco Control Project.

PubMed

Partos, Timea R; Gilmore, Anna B; Hitchman, Sara C; Hiscock, Rosemary; Branston, J Robert; McNeill, Ann

2018-05-03

Raising tobacco prices is the most effective population-level intervention for reducing smoking, but this is undermined by the availability of cheap tobacco. This study monitors trends in cheap tobacco use among adult smokers in the United Kingdom between 2002 and 2014 via changes in product type, purchase source, and prices paid. Weighted data from 10 waves of the International Tobacco Control policy evaluation study were used. This is a longitudinal cohort study of adult smokers with replenishment; 6169 participants provided 15812 responses. Analyses contrasted (1) product type: roll-your-own (RYO) tobacco, factory-made packs (FM-P), and factory-made cartons (FM-C); (2) purchase source: UK store-based sources (e.g., supermarkets and convenience stores) with non-UK/nonstore sources representing tax avoidance/evasion (e.g., outside the UK, duty free, and informal sellers); and (3) prices paid (inflation-adjusted to 2014 values). Generalized estimating equations tested linear changes over time. (1) RYO use increased significantly over time as FM decreased. (2) UK store-based sources constituted approximately 80% of purchases over time, with no significant increases in tax avoidance/evasion. (3) Median RYO prices were less than half that of FM, with FM-C cheaper than FM-P. Non-UK/nonstore sources were cheapest. Price increases of all three product types from UK store-based sources from 2002 to 2014 were statistically significant but not substantial. Wide (and increasing for FM-P) price ranges meant each product type could be purchased in 2014 at prices below their 2002 medians from UK store-based sources. Options exist driving UK smokers to minimize their tobacco expenditure; smokers do so largely by purchasing cheap tobacco products from UK stores. The effectiveness of price increases as a deterrent to smoking is being undermined by the availability of cheap tobacco such as roll-your-own tobacco and cartons of packs of factory-made cigarettes. Wide price ranges allowed smokers in 2014 to easily obtain cigarettes at prices comparable to 12 years prior, without resorting to tax avoidance or evasion. UK store-based sources accounted for 80% or more of all tobacco purchases between 2002 and 2014, suggesting little change in tax avoidance or evasion over time. There was a widening price range between the cheapest and most expensive factory-made cigarettes.

Availability and Use of Cheap Tobacco in the United Kingdom 2002–2014: Findings From the International Tobacco Control Project

PubMed Central

Partos, Timea R; Gilmore, Anna B; Hitchman, Sara C; Hiscock, Rosemary; Branston, J Robert; McNeill, Ann

2018-01-01

Abstract Introduction Raising tobacco prices is the most effective population-level intervention for reducing smoking, but this is undermined by the availability of cheap tobacco. This study monitors trends in cheap tobacco use among adult smokers in the United Kingdom between 2002 and 2014 via changes in product type, purchase source, and prices paid. Methods Weighted data from 10 waves of the International Tobacco Control policy evaluation study were used. This is a longitudinal cohort study of adult smokers with replenishment; 6169 participants provided 15812 responses. Analyses contrasted (1) product type: roll-your-own (RYO) tobacco, factory-made packs (FM-P), and factory-made cartons (FM-C); (2) purchase source: UK store-based sources (e.g., supermarkets and convenience stores) with non-UK/nonstore sources representing tax avoidance/evasion (e.g., outside the UK, duty free, and informal sellers); and (3) prices paid (inflation-adjusted to 2014 values). Generalized estimating equations tested linear changes over time. Results (1) RYO use increased significantly over time as FM decreased. (2) UK store-based sources constituted approximately 80% of purchases over time, with no significant increases in tax avoidance/evasion. (3) Median RYO prices were less than half that of FM, with FM-C cheaper than FM-P. Non-UK/nonstore sources were cheapest. Price increases of all three product types from UK store-based sources from 2002 to 2014 were statistically significant but not substantial. Wide (and increasing for FM-P) price ranges meant each product type could be purchased in 2014 at prices below their 2002 medians from UK store-based sources. Conclusions Options exist driving UK smokers to minimize their tobacco expenditure; smokers do so largely by purchasing cheap tobacco products from UK stores. Implications The effectiveness of price increases as a deterrent to smoking is being undermined by the availability of cheap tobacco such as roll-your-own tobacco and cartons of packs of factory-made cigarettes. Wide price ranges allowed smokers in 2014 to easily obtain cigarettes at prices comparable to 12 years prior, without resorting to tax avoidance or evasion. UK store-based sources accounted for 80% or more of all tobacco purchases between 2002 and 2014, suggesting little change in tax avoidance or evasion over time. There was a widening price range between the cheapest and most expensive factory-made cigarettes. PMID:28525594

Enhancing quality improvements in cancer care through CME activities at a nationally recognized cancer center.

PubMed

Uemura, Marc; Morgan, Robert; Mendelsohn, Mary; Kagan, Jean; Saavedra, Crystal; Leong, Lucille

2013-06-01

Changing healthcare policy will undoubtedly affect the healthcare environment in which providers function. The current Fee for Service reimbursement model will be replaced by Value-Based Purchasing, where higher quality and more efficient care will be emphasized. Because of this, large healthcare organizations and individual providers must adapt to incorporate performance outcomes into patient care. Here, we present a Continuing Medical Education (CME)-based initiative at the City of Hope National Cancer Center that we believe can serve as a model for using CME as a value added component to achieving such a goal.

Food concerns and support for environmental food policies and purchasing.

PubMed

Worsley, Anthony; Wang, Wei C; Burton, Melissa

2015-08-01

Consumer support for pro environmental food policies and food purchasing are important for the adoption of successful environmental policies. This paper examines consumers' views of food policy options as their predisposition to purchase pro environmental foods along with their likely demographic, educational and cognitive antecedents including food and environmental concerns and universalism values (relating to care for others and the environment). An online survey to assess these constructs was conducted among 2204 Australian adults in November 2011. The findings showed strong levels of support for both environmental food policies (50%-78% support) and pro environmental food purchasing (51%-69% intending to purchase pro environmental foods). Confirmatory factor analysis and structural equation modelling showed that different cognitive mediators exist along pathways between demographics and the two outcome variables. Support for food policy was positively related to food and environment concerns (std. Beta = 0.25), universalism (0.41), perceived control (0.07), and regulatory issues (0.64 but negatively with food security issues (-0.37). Environment purchasing intentions were positively linked to food and nutrition concerns (0.13), food and environment concerns (0.24), food safety concerns (0.19), food and animal welfare concerns (0.16), universalism (0.25), female gender (0.05), education (0.04), and perceived influence over the food system (0.17). In addition, health study in years 11 and 12 was positively related to the beginning of both of these pathways (0.07 for each). The results are discussed in relation to the opportunities that communications based on the mediating variables offer for the promotion of environmental food policies and purchasing. Copyright © 2015 Elsevier Ltd. All rights reserved.

Sodium content of processed foods in the United Kingdom: analysis of 44,000 foods purchased by 21,000 households123

PubMed Central

Capelin, Cathy; Dunford, Elizabeth K; Webster, Jacqueline L; Neal, Bruce C; Jebb, Susan A

2011-01-01

Background: In the United Kingdom, sodium reduction targets have been set for a large number of processed food categories. Assessment and monitoring are essential to evaluate progress. Objectives: Our aim was to determine whether household consumer panel food-purchasing data could be used to assess the sodium content of processed foods. Our further objectives were to estimate the mean sodium content of UK foods by category and undertake analyses weighted by food-purchasing volumes. Design: Data were obtained for 21,108 British households between October 2008 and September 2009. Purchasing data (product description, product weight, annual purchases) and sodium values (mg/100 g) were collated for all food categories known to be major contributors to sodium intake. Unweighted and weighted mean sodium values were calculated. Results: Data were available for 44,372 food products. The largest contributors to sodium purchases were table salt (23%), processed meat (18%), bread and bakery products (13%), dairy products (12%), and sauces and spreads (11%). More than one-third of sodium purchased (37%) was accounted for by 5 food categories: bacon, bread, milk, cheese, and sauces. For some food groups (bread and bakery, cereals and cereal products, processed meat), purchase-weighted means were 18–35% higher than unweighted means, suggesting that market leaders have higher sodium contents than the category mean. Conclusion: The targeting of sodium reduction in a small number of food categories and focusing on products sold in the highest volumes could lead to large decreases in sodium available for consumption and therefore to gains in public health. PMID:21191142

Sodium content of processed foods in the United Kingdom: analysis of 44,000 foods purchased by 21,000 households.

PubMed

Ni Mhurchu, Cliona; Capelin, Cathy; Dunford, Elizabeth K; Webster, Jacqueline L; Neal, Bruce C; Jebb, Susan A

2011-03-01

In the United Kingdom, sodium reduction targets have been set for a large number of processed food categories. Assessment and monitoring are essential to evaluate progress. Our aim was to determine whether household consumer panel food-purchasing data could be used to assess the sodium content of processed foods. Our further objectives were to estimate the mean sodium content of UK foods by category and undertake analyses weighted by food-purchasing volumes. Data were obtained for 21,108 British households between October 2008 and September 2009. Purchasing data (product description, product weight, annual purchases) and sodium values (mg/100 g) were collated for all food categories known to be major contributors to sodium intake. Unweighted and weighted mean sodium values were calculated. Data were available for 44,372 food products. The largest contributors to sodium purchases were table salt (23%), processed meat (18%), bread and bakery products (13%), dairy products (12%), and sauces and spreads (11%). More than one-third of sodium purchased (37%) was accounted for by 5 food categories: bacon, bread, milk, cheese, and sauces. For some food groups (bread and bakery, cereals and cereal products, processed meat), purchase-weighted means were 18-35% higher than unweighted means, suggesting that market leaders have higher sodium contents than the category mean. The targeting of sodium reduction in a small number of food categories and focusing on products sold in the highest volumes could lead to large decreases in sodium available for consumption and therefore to gains in public health.

Spend today, clean tomorrow: Predicting methamphetamine abstinence in a randomized controlled trial

PubMed Central

Murtaugh, Kimberly Ling; Krishnamurti, Tamar; Davis, Alexander L.; Reback, Cathy J.; Shoptaw, Steven

2013-01-01

Objective This secondary analysis of data from a randomized controlled trial tested two behavioral economics mechanisms (substitutability and delay discounting) to explain outcomes using contingency management (CM) for methamphetamine dependence. Frequency and purchase type (hedonic/utilitarian and consumable/durable) of CM payments were also examined. Methods 82 methamphetamine-dependent gay/bisexual men randomly assigned to conditions delivering CM received monetary vouchers in exchange for stimulant-negative urine samples in a 16-week trial requiring thrice weekly visits (Shoptaw et al., 2005). At any visit participants could redeem vouchers for goods. A time-lagged counting process Cox Proportional Hazards model for recurrent event survival analysis examined aspects of the frequency and type of these CM purchases. Results After controlling for severity of baseline methamphetamine use and accumulated CM wealth, as measured by cumulative successful earning days, participants who redeemed CM earnings at any visit (“spenders”) were significantly more likely to produce stimulant-negative urine samples in the subsequent visit, compared to those who did not redeem (“savers”) 1.011* [1.005, 1.017], Z=3.43, p<0.001. Conclusions Findings support the economic concept of substitutability of CM purchases and explain trial outcomes as a function of frequency of CM purchases rather than frequency or accumulated total CM earnings. Promotion of frequent purchases in incentive-based programs should facilitate substitution for the perceived value of methamphetamine and improve abstinence outcomes. PMID:24001246

Understanding Corporate Sponsorships: Moving from a $100 Ad Purchase to a $1,000 Sponsorship Agreement

ERIC Educational Resources Information Center

Hatfield, Laura M.; Hatfield, Lance C.

2014-01-01

A corporate sponsorship program, built on an appropriate knowledge base, can help bridge the funding gap that exists in interscholastic athletics between the cost of fielding teams and decreasing budget allocations. This article describes sponsorship in its most effective form as a business concept, the value that athletic departments provide to…

DoD and DOS Need Better Procedures to Monitor and Expend DoD Funds for the Afghan National Police Training Program

DTIC Science & Technology

2011-07-07

charged the Government for unreasonable roundtrip airline tickets, a one day rental car and parking fees of $104 even though other transportation...purchases was based on high dollar values, and the items included equipment, parts, cell phones, catered meals, fuel, and rental vehicles listed on 10

[Pitfalls in international comparisons of health data and indices].

PubMed

Rotstein, Z; Shani, M

1991-05-01

Comparison of published data and health indices from different countries with different health systems is subject to many pitfalls. Comparison of national expenditure for health care based on purchasing power of the currency may be misleading if the purchasing power of the health services is ignored. Comparisons may also be misleading if they ignore national geographic and demographic structures. Government and health authorities often quote different sets of data and use different terminology and definitions. This article stresses the disparity in the definition of medical manpower and points out differences relating to ratios of manpower to population and to per capita spending. Also addressed is the importance of the qualitative and value aspects of health systems not usually involved in comparison of international health indices. In conclusion, safety measures and precautions such as choosing the right index for the right purpose, adjustment of indices to the purchasing power parity of health, demographics, etc., should be used when conducting health care analyses.

Consumption of vegetables and their relation with ultra-processed foods in Brazil

PubMed Central

Canella, Daniela Silva; Louzada, Maria Laura da Costa; Claro, Rafael Moreira; Costa, Janaina Calu; Bandoni, Daniel Henrique; Levy, Renata Bertazzi; Martins, Ana Paula Bortoletto

2018-01-01

ABSTRACT OBJECTIVE To characterize the household purchase and the individual consumption of vegetables in Brazil and to analyze their relation with the consumption of ultra-processed foods. METHODS We have used data on the purchase of food for household consumption and individual consumption from the 2008–2009 Brazilian Household Budget Survey. The Brazilian Household Budget Survey studied the purchase of food of 55,970 households and the food consumption of 34,003 individuals aged 10 years and over. The foods of interest in this study were vegetables (excluding roots and tubers) and ultra-processed foods. We have described the amount of vegetables (grams) purchased and consumed by all Brazilians and according to the quintiles of caloric intake of ultra-processed food. To this end, we have calculated the crude and predicted values obtained by regression models adjusted for sociodemographic variables. We have analyzed the most commonly purchased types of vegetables (% in the total amount) and, in relation to individual food consumption, the variety of vegetables consumed (absolute number), the participation (%) of the types of culinary preparations based on vegetables, and the time of consumption. RESULTS The adjusted mean household purchase of vegetables was 42.9 g/per capita/day. The adjusted mean individual consumption was 46.1 g. There was an inverse relation between household purchase and individual consumption of vegetables and ultra-processed foods. Ten types of vegetables account for more than 80% of the total amount usually purchased. The variety consumed was, on average, 1.08 type/per capita/day. Approximately 60% of the vegetables were eaten raw, and the amount consumed at lunch was twice that consumed at dinner; individuals with higher consumption of ultra-processed foods tended to consume even less vegetables at dinner. CONCLUSIONS The consumption of vegetables in Brazil is insufficient, and this is worse among individuals with higher consumption of ultra-processed foods. The most frequent habit was to consume raw vegetables at lunch and with limited variety. PMID:29791530

Purchaser strategies to influence quality of care: from rhetoric to global applications.

PubMed

McNamara, P

2006-06-01

The potential of purchasers to influence the quality and safety of care has captured the attention of health sector leaders worldwide. Quality based purchasing explicitly seeks to hold providers accountable for the quality and safety of care. Three strategies are available to purchasers: (1) selective contracting based on quality; (2) payment differentials based on quality; and (3) sponsorship of comparative provider report cards. Examples are given to illustrate each of the three strategies. Governments, employers, social insurance funds, community based insurance organizations, health plans, donors, and other buyers of health services are encouraged to explore and debate these purchaser strategies within the context of an overarching national or local quality framework. Public and private funders of operations research are encouraged to support and disseminate evaluations of purchaser efforts to improve quality. This paper is designed to highlight and frame purchasers' strategies explicitly crafted to enhance the quality and safety of care. The ultimate aim is to encourage thoughtful discussion about whether or not one or more purchaser strategy might support a particular country's goals to improve care. Experiences from both developed and developing countries are included to facilitate the exchange of ideas and provide the broadest of perspectives.

Medical technology procurement in Europe: a cross-country comparison of current practice and policy.

PubMed

Sorenson, Corinna; Kanavos, Panos

2011-04-01

Procurement policy can influence the diffusion of medical devices into national health systems, but limited comparative evidence exists on how countries procure such technologies. This paper discusses the procurement of select medical devices across five countries (England, France, Germany, Italy, and Spain) based on a review of published and grey literature and policy documents, as well as expert interviews. All countries have introduced various regulatory or policy measures that implicitly or explicitly influence device procurement, from lists of devices for purchase to changes in financing mechanisms. There has also been movement toward more centralized procurement with the introduction of purchasing groups or consortiums, notably in England, France, Germany, and Italy. While a number of stakeholder groups are involved in purchasing activities, a greater, more formalized role for physicians and governments is needed to ensure that technologies procured best meet patient needs and align with national health care priorities and other sectoral objectives. A general theme across all national procurement systems was a focus on cost-containment, but like other areas of technology policy (e.g., coverage), basing purchasing decisions on a broader range of criteria, such as quality and health outcomes, might better allow governments to achieve value for money and support patient access to beneficial innovations. More research is needed, however, to substantiate the role and influence of procurement on balancing the adoption and affordability of medical technologies. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Purchasing Over-the-counter medicines from Australian pharmacy: What do the pharmacy customers value and expect?

PubMed

Chan, Vincent; Tran, Hung

2016-01-01

Over-the-counter medicines (OTC) are widely available and can be purchased without a prescription. Their availability means that a customer may choose to purchase them without the involvement of a pharmacy/pharmacist. It is important to understand customer OTC purchasing perceptions and behaviour from a pharmacy to better understand the needs and opportunities in this space. This study aimed to examine customers' key expectations and what they value when purchasing OTC and how the effect of health status/stress and perceived risks/benefits of purchasing OTCs from a pharmacy may influence their OTC shopping behaviour. Customers from two metropolitan pharmacies across two different suburbs in Brisbane, Queensland, Australia completed a self-administered questionnaire. Data collection was conducted over a six-week period. The questionnaire examined demographics, current level of health and stress, as well as a range of questions (seven-point Likert-scale) examining perceived benefits and risks, what they value, trust and expect when purchasing OTC. A total of 86 customers from a broad range of demographics were captured in this study. When asked about their current health state, 41% and 23% respectively indicated that they were stressed and tense when they arrived at the pharmacy but many were feeling well (38%). Most customers strongly agreed/agreed that trust in the advice from a pharmacy (96%), trust in the products (73%), and the altruistic approach of a pharmacy (95%) were critical to them. Further, 82% and 78% respectively disagreed that time pressures or costs were concerns, despite many feeling tense and stressed when they came in. When asked where they intend to buy their future OTC, 89% indicated pharmacy instead of a supermarket. High levels of trust, confidence and sense of altruism and care were key factors for customers buying OTC from a pharmacy, regardless of time pressures, costs or existing levels of stress and health.

Purchasing Over-the-counter medicines from Australian pharmacy: What do the pharmacy customers value and expect?

PubMed Central

2016-01-01

Background: Over-the-counter medicines (OTC) are widely available and can be purchased without a prescription. Their availability means that a customer may choose to purchase them without the involvement of a pharmacy/pharmacist. It is important to understand customer OTC purchasing perceptions and behaviour from a pharmacy to better understand the needs and opportunities in this space. Objective: This study aimed to examine customers’ key expectations and what they value when purchasing OTC and how the effect of health status/stress and perceived risks/benefits of purchasing OTCs from a pharmacy may influence their OTC shopping behaviour. Methods: Customers from two metropolitan pharmacies across two different suburbs in Brisbane, Queensland, Australia completed a self-administered questionnaire. Data collection was conducted over a six-week period. The questionnaire examined demographics, current level of health and stress, as well as a range of questions (seven-point Likert-scale) examining perceived benefits and risks, what they value, trust and expect when purchasing OTC. Results: A total of 86 customers from a broad range of demographics were captured in this study. When asked about their current health state, 41% and 23% respectively indicated that they were stressed and tense when they arrived at the pharmacy but many were feeling well (38%). Most customers strongly agreed/agreed that trust in the advice from a pharmacy (96%), trust in the products (73%), and the altruistic approach of a pharmacy (95%) were critical to them. Further, 82% and 78% respectively disagreed that time pressures or costs were concerns, despite many feeling tense and stressed when they came in. When asked where they intend to buy their future OTC, 89% indicated pharmacy instead of a supermarket. Conclusions: High levels of trust, confidence and sense of altruism and care were key factors for customers buying OTC from a pharmacy, regardless of time pressures, costs or existing levels of stress and health. PMID:27785164

Price and maternal obesity influence purchasing of low- and high-energy-dense foods2

PubMed Central

Epstein, Leonard H; Dearing, Kelly K; Paluch, Rocco A; Roemmich, James N; Cho, David

2007-01-01

Background Price can influence food purchases, which can influence consumption. Limited laboratory research has assessed the effect of price changes on food purchases, and no research on individual differences that may interact with price to influence purchases exists. Objective We aimed to assess the influence of price changes of low-energy-density (LED) and high-energy-density (HED) foods on mother’s food purchases in a laboratory food-purchasing analogue. Design Mothers were randomly assigned to price conditions in which the price of either LED or HED foods was manipulated from 75% to 125% of the reference purchase price, whereas the price of the alternative foods was kept at the reference value. Mothers completed purchases for 2 income levels ($15 or $30 per family member). Results Purchases were reduced when prices of LED (P < 0.01) and HED (P < 0.001) foods were increased. Maternal BMI interacted with price to influence purchases of HED foods when the price of HED foods increased (P = 0.016) and interacted with price to influence purchases of LED foods when the price of HED foods increased (P = 0.008). Conclusion These results show the relevance of considering price change as a way to influence food purchases of LED compared with HED foods and the possibility that individual differences may influence the own-price elasticity of HED foods and substitution of LED for HED foods. PMID:17921365

Price and maternal obesity influence purchasing of low- and high-energy-dense foods.

PubMed

Epstein, Leonard H; Dearing, Kelly K; Paluch, Rocco A; Roemmich, James N; Cho, David

2007-10-01

Price can influence food purchases, which can influence consumption. Limited laboratory research has assessed the effect of price changes on food purchases, and no research on individual differences that may interact with price to influence purchases exists. We aimed to assess the influence of price changes of low-energy-density (LED) and high-energy-density (HED) foods on mother's food purchases in a laboratory food-purchasing analogue. Mothers were randomly assigned to price conditions in which the price of either LED or HED foods was manipulated from 75% to 125% of the reference purchase price, whereas the price of the alternative foods was kept at the reference value. Mothers completed purchases for 2 income levels ($15 or $30 per family member). Purchases were reduced when prices of LED (P < 0.01) and HED (P < 0.001) foods were increased. Maternal BMI interacted with price to influence purchases of HED foods when the price of HED foods increased (P = 0.016) and interacted with price to influence purchases of LED foods when the price of HED foods increased (P = 0.008). These results show the relevance of considering price change as a way to influence food purchases of LED compared with HED foods and the possibility that individual differences may influence the own-price elasticity of HED foods and substitution of LED for HED foods.

Reinforcing value and hypothetical behavioral economic demand for food and their relation to BMI.

PubMed

Epstein, Leonard H; Paluch, Rocco A; Carr, Katelyn A; Temple, Jennifer L; Bickel, Warren K; MacKillop, James

2018-04-01

Food is a primary reinforcer, and food reinforcement is related to obesity. The reinforcing value of food can be measured by establishing how hard someone will work to get food on progressive-ratio schedules. An alternative way to measure food reinforcement is a hypothetical purchase task which creates behavioral economic demand curves. This paper studies whether reinforcing value and hypothetical behavioral demand approaches are assessing the same or unique aspects of food reinforcement for low (LED) and high (HED) energy density foods using a combination of analytic approaches in females of varying BMI. Results showed absolute reinforcing value for LED and HED foods and relative reinforcing value were related to demand intensity (r's = 0.20-0.30, p's < 0.01), and demand elasticity (r's = 0.17-0.22, p's < 0.05). Correlations between demographic, BMI and restraint, disinhibition and hunger variables with the two measures of food reinforcement were different. Finally, the two measures provided unique contributions to predicting BMI. Potential reasons for differences between the reinforcing value and hypothetical purchase tasks were actual responding versus hypothetical purchasing, choice of reinforcers versus purchasing of individual foods in the demand task, and the differential role of effort in the two tasks. Examples of how a better understanding of food reinforcement may be useful to prevent or treat obesity are discussed, including engaging in alternative non-food reinforcers as substitutes for food, such as crafts or socializing in a non-food environment, and reducing the value of immediate food reinforcers by episodic future thinking. Copyright © 2018. Published by Elsevier Ltd.

Charting the Emergence of Corporate Procurement of Utility-Scale PV

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

Heeter, Jenny S.; Cook, Jeffrey J.; Bird, Lori A.

Corporations and other institutions have contracted for more than 2300 MW of off-site solar, using power purchase agreements, green tariffs, or bilateral deals with utilities. This paper examines the benefits, challenges, and outlooks for large-scale off-site solar purchasing in the United States. Pathways differ based on where they are available, the hedge value they can provide, and their ease of implementation. The paper features case studies of an aggregate PPA (Massachusetts Institute of Technology, Boston Medical Center, and Post Office Square), a corporation exiting their incumbent utility (MGM Resorts), a utility offering large scale renewables to corporate customers (Alabama Powersmore » Renewable Procurement Program), and a company with approval to sell energy into wholesale markets (Google Energy Inc.).« less

Understanding Hospital Value-Based Purchasing.

PubMed

Brooks, Jo Ann

2016-05-01

This column is designed to provide a nursing perspective on new hospital quality measurements. Future articles will cover the various quality indicators hospitals face and the role of the nurse in meeting mandated benchmarks. Reader responses to this column are welcome and will help to make it more useful to nurses in meeting the challenges posed by health care reform and changing Medicare reimbursement programs.

Questionable validity of the catheter-associated urinary tract infection metric used for value-based purchasing.

PubMed

Calderon, Lindsay E; Kavanagh, Kevin T; Rice, Mara K

2015-10-01

Catheter-associated urinary tract infections (CAUTIs) occur in 290,000 US hospital patients annually, with an estimated cost of $290 million. Two different measurement systems are being used to track the US health care system's performance in lowering the rate of CAUTIs. Since 2010, the Agency for Healthcare Research and Quality (AHRQ) metric has shown a 28.2% decrease in CAUTI, whereas the Centers for Disease Control and Prevention metric has shown a 3%-6% increase in CAUTI since 2009. Differences in data acquisition and the definition of the denominator may explain this discrepancy. The AHRQ metric analyzes chart-audited data and reflects both catheter use and care. The Centers for Disease Control and Prevention metric analyzes self-reported data and primarily reflects catheter care. Because analysis of the AHRQ metric showed a progressive change in performance over time and the scientific literature supports the importance of catheter use in the prevention of CAUTI, it is suggested that risk-adjusted catheter-use data be incorporated into metrics that are used for determining facility performance and for value-based purchasing initiatives. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Women, infants, and children cash value voucher (CVV) use in Arizona: a qualitative exploration of barriers and strategies related to fruit and vegetable purchases.

PubMed

Bertmann, Farryl M W; Barroso, Cristina; Ohri-Vachaspati, Punam; Hampl, Jeffrey S; Sell, Karen; Wharton, Christopher M

2014-01-01

Women, Infants, and Children (WIC) cash value vouchers (CVV) have been inconsistently redeemed in Arizona. The objective of this study was to explore perceived barriers to use of CVV as well as strategies participants use to overcome them. Eight focus groups were conducted to explore attitudes and behaviors related to CVV use. Focus groups were conducted at 2 WIC clinics in metro-Phoenix, AZ. Participants in WIC who were at least 18 years of age and primarily responsible for buying and preparing food for their households. Perceived barriers to CVV use and strategies used to maximize their purchasing value. Transcripts were analyzed using a general inductive approach to identify emergent themes. Among 41 participants, multiple perceived barriers emerged, such as negative interactions in stores or confusion over WIC rules. Among experienced shoppers, WIC strategies also emerged to deal with barriers and maximize CVV value, including strategic choice of times and locations at which to shop and use of price-matching, rewards points, and other ways to increase purchasing power. Arizona WIC participants perceived barriers that limit easy redemption of CVV. Useful strategies were also identified that could be important to explore further to improve WIC CVV purchasing experiences. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

40 CFR 90.703 - Production line testing by the manufacturer.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) Manufacturers of small SI engines shall test production line engines from each engine family according to the... recommended to the ultimate purchaser, unless otherwise specified by the Administrator. The Administrator may specify values within or without the range recommended to the ultimate purchaser. ...

School District Purchasing.

ERIC Educational Resources Information Center

Natale, Joseph L.

This chapter of "Principles of School Business Management" discusses the effective management of purchasing processes in a school district. These processes include obtaining materials, supplies, and equipment of maximum value for the least expense, and receiving, storing, and distributing the items obtained. The chapter opens with an overview of…

How important is local food to organic-minded consumers?

PubMed

Hempel, Corinna; Hamm, Ulrich

2016-01-01

The study deals with German consumers' attitudes towards organic food and local food, their food purchase behaviour and their personal characteristics. The purpose is to investigate the differences in attitudes and willingness-to-pay values between consumers who consider the organic production of food (very) important and those who consider it less important. This study combines a consumer survey with an in-store, discrete choice experiment. In the analysis, findings from the consumer survey were related to the choices made by consumers in the experiment. Consumers' preferences and willingness-to-pay values were estimated through random parameter logit modelling. Organic-minded consumers (i.e. those who regarded organic food production as (very) important in the survey) have stronger preferences and estimated willingness-to-pay values for organic as well as local products. Locally produced food, as opposed to food from neighbouring countries or non-EU countries, is preferred over organically produced food by both consumer groups which demonstrates that organic-minded consumers do not only consider organic food production as important, but also value local food production in a purchase situation. Hence, it can be assumed that local food production complements organic food production for the group of organic-minded consumers. This contribution is the first study dealing with local and organic food purchase behaviour in Germany that examines four different products and is carried out in rural as well as urban locations in four different regions. Due to the application of a choice experiment including no-choice options and binding purchase decisions, the results are expected to be closer to real purchase situations than results of direct questioning and choice experiments in online applications. Copyright © 2015 Elsevier Ltd. All rights reserved.

77 FR 38553 - Proposed Modification to Regulation Concerning the Use of Market Economy Input Prices in...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-28

...The Department of Commerce (``Department'') proposes to modify its regulation which states that the Department normally will use the price that a nonmarket economy (``NME'') producer pays to a market economy supplier when a factor of production is purchased from a market economy supplier and paid for in market economy currency, in the calculation of normal value (``NV'') in antidumping proceedings involving NME countries. The rule, if adopted, would establish (1) a requirement that the input at issue be produced in one or more market economy countries, and (2) a revised threshold requiring that ``substantially all'' of an input be purchased from one or more market economy suppliers before the Department would use the purchase price paid to value the entire factor of production. Through this proposed modification, the Department is announcing its proposed definition of ``substantially all'' to be 85 percent of the total purchased volume of the particular input. The Department invites public comment on this proposed change.

Assessing the State of Procurement Knowledge Production: Implications for the Federal Government

DTIC Science & Technology

2011-10-31

NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND...archiving of the canonical knowledge base, quality control of published information, and assignment of priority and credit for their work to authors...recognizes the value of theory-based research and graduate education in strategic purchasing—evidenced by its investment in an acclaimed strategic purchasing

The Air Force Needs to Improve Cost-Effectiveness and Availability of the Joint Surveillance Target Attack Radar System (Redacted)

DTIC Science & Technology

2016-11-01

Target Attack Radar System Objective We determined whether the Air Force made cost-effective purchases on the performance-based logistics contract to... contract to Northrop Grumman Corporation to provide Total System Support Responsibility services to sustain 16 E-8C JSTARS aircraft. These services...customer support. The Total System Support Responsibility contract is valued at $7 billion, with a 6-year base period and 16 annual contract option

Connecting plug-in vehicles with green electricity through consumer demand

NASA Astrophysics Data System (ADS)

Axsen, Jonn; Kurani, Kenneth S.

2013-03-01

The environmental benefits of plug-in electric vehicles (PEVs) increase if the vehicles are powered by electricity from ‘green’ sources such as solar, wind or small-scale hydroelectricity. Here, we explore the potential to build a market that pairs consumer purchases of PEVs with purchases of green electricity. We implement a web-based survey with three US samples defined by vehicle purchases: conventional new vehicle buyers (n = 1064), hybrid vehicle buyers (n = 364) and PEV buyers (n = 74). Respondents state their interest in a PEV as their next vehicle, in purchasing green electricity in one of three ways, i.e., monthly subscription, two-year lease or solar panel purchase, and in combining the two products. Although we find that a link between PEVs and green electricity is not presently strong in the consciousness of most consumers, the combination is attractive to some consumers when presented. Across all three respondent segments, pairing a PEV with a green electricity program increased interest in PEVs—with a 23% demand increase among buyers of conventional vehicles. Overall, about one-third of respondents presently value the combination of a PEV with green electricity; the proportion is much higher among previous HEV and PEV buyers. Respondents’ reported motives for interest in both products and their combination include financial savings (particularly among conventional buyers), concerns about air pollution and the environment, and interest in new technology (particularly among PEV buyers). The results provide guidance regarding policy and marketing strategies to advance PEVs and green electricity demand.

Life cycle impact assessment weights to support environmentally preferable purchasing in the United States.

PubMed

Gloria, Thomas P; Lippiatt, Barbara C; Cooper, Jennifer

2007-11-01

LCA is a quantitative method for understanding the environmental impacts of a product, yet all product purchasing decisions are ultimately subjective. Weights are the nexus between the quantitative results of LCA and the values-based, subjective choices of decision makers. In May 2007, NIST introduced a new optional weight set in Version 4.0 of the BEES software. Three key points about this new optional weight set are the basis for discussion in this paper: The new weight set was created specifically in the context of BEES. It is intended to support a practical method to assist environmentally preferable purchasing in the United States based on LCIA results. This is in contrast to the weight sets currently in BEES, which are based on generalist perspectives. The new weight set was created by a multi-stakeholder panel via the AHP method, and is a synthesis of panelists' perspectives on the relative importance of each environmental impact category in BEES. The weight set draws on each panelist's personal and professional understanding of, and value attributed to, each impact category. While the synthesized weight set may not equally satisfy each panelist's view of impact importance, it does reflect contemporary values in applying LCAto real world decisions, and represents one approach others can learn from in producing weight sets. The new weight set offers BEES users an additional option for synthesizing and comparing the environmental performance of building products and making purchasing decisions. In so doing, it strengthens the decision-making process, which is important when making product comparisons in the public domain. The Weight Set: Across all panelists and with explicit consideration of all time horizons, anthropogenic contributions to global warming, weighted at 29%, was judged most important, yet not so important that decisions can be made solely on the basis of this impact. A strong tail of other concerns include fossil fuel depletion (10%), criteria air pollutants (9%), water intake/use (8%), human health cancerous effects (8%), ecological toxicity (7%), eutrophication of water bodies (6%), land use (6%), and human health noncancerous effects (5%). Also of interest are the identified impact areas of concern assigned the lowest weights: smog formation (4%), indoor air quality (3%), acidification (3%), and ozone depletion (2%). Their low weights may indicate that there is not as much immediate concern or that the remedial actions associated with the impact for the most part are underway.

Quality-based purchasing in health care.

PubMed

Waters, Hugh R; Morlock, Laura L; Hatt, Laurel

2004-01-01

Quality-based purchasing is a growing trend that seeks to improve healthcare quality through the purchaser-provider relationship. This article provides a unifying conceptual framework, presents examples of the purchaser-provider relationship in countries at different income levels, and identifies important supporting mechanisms for quality-based purchasing. As countries become wealthier, a higher proportion of healthcare spending is channeled through pooled arrangements, allowing for greater involvement of purchasers in promoting the quality of service provision. Global and line item budgets are the most common type of provider payment system in low and middle-income countries. In these countries, improving public hospital performance through contracting and incentives is a key issue. In middle and high-income countries, there are several documented examples of governments contracting to private or non-governmental health care providers, resulting in higher perceived quality of care and lower delivery costs. Encouraging quality through employer purchasing arrangements has been promoted in several countries, particularly the United States. Community-based financing schemes are an increasingly common form of health financing in parts of sub-Saharan Africa and Asia, but these schemes still cover less than 10% of national populations in countries in which they are active. To date, there is little evidence of their impact on healthcare quality. The availability of information--concerning healthcare service provision and outcomes--determines the options for establishing and monitoring contract provisions and promoting quality. Regardless of the context, quality-based purchasing depends critically on informa-tion--reporting, monitoring, and providing useful information to healthcare consumers. In many low and middle-income countries, the lack of availability of information is the principal constraint on measuring performance, a critical component of quality-based purchasing.

Sugar and total energy content of household food purchases in Brazil.

PubMed

Levy, Renata Bertazzi; Claro, Rafael Moreira; Monteiro, Carlos Augusto

2009-11-01

To study the role of energy derived from sugar (both table sugar and sugar added to processed foods) in the total energy content of food purchases in Brazil. Food purchase data were collected during a national household budget survey carried out between June 2002 and July 2003 on a probabilistic sample representative of all households in the country. The amount of food purchased in this 12-month period was transformed into energy and energy from sugar using food composition tables. Multiple linear regression models were used to study the association between amount of energy from sugar and total energy content of food purchases, controlling for sociodemographic variables and potential interactions between these variables and sugar purchases. There was a positive and significant association between energy from sugar and total household energy purchases. A 1 kJ increase in sugar purchase corresponded to a 3.637 kJ increase in total energy. In the absence of expenditure on meals outside the home, i.e. when household food purchases tend to approximate actual food consumption by household members, sugar purchase of 1926.35 kJ/d (the 90th percentile of the distribution of sugar purchases in Brazil) was associated, depending on income strata, with total energy purchase over 40-60 % of the recommended daily value for energy intake in Brazil. The present results corroborate the recommendations of the WHO and the Brazilian Ministry of Health regarding limiting the consumption of sugar.

Collective purchase behavior toward retail price changes

NASA Astrophysics Data System (ADS)

Ueno, Hiromichi; Watanabe, Tsutomu; Takayasu, Hideki; Takayasu, Misako

2011-02-01

By analyzing a huge amount of point-of-sale data collected from Japanese supermarkets, we find power law relationships between price and sales numbers. The estimated values of the exponents of these power laws depend on the category of products; however, they are independent of the stores, thereby implying the existence of universal human purchase behavior. The rate of sales numbers around these power laws are generally approximated by log-normal distributions implying that there are hidden random parameters, which might proportionally affect the purchase activity.

Health information technology: help or hindrance?

PubMed

Ketchersid, Terry

2014-07-01

The practice of medicine in general and nephrology in particular grows increasingly complex with each passing year. In parallel with this trend, the purchasers of health care are slowly shifting the reimbursement paradigm from one based on rewarding transactions, or work performed, to one that rewards value delivered. Within this context, the health-care value equation is broadly defined as quality divided by costs. Health information technology has been widely recognized as 1 of the foundations for delivering better care at lower costs. As the largest purchaser of health care in the world, the Centers for Medicare and Medicaid Services has deployed a series of interrelated programs designed to spur the adoption and utilization of health information technology. This review examines our known collective experience in the practice of nephrology to date with several of these programs and attempts to answer the following question: Is health information technology helping or hindering the delivery of value to the nation's health-care system? Through this review, it was concluded overall that the effect of health information technology appears positive; however, it cannot be objectively determined because of the infancy of its utilization in the practice of medicine. Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Consortium Purchases: Case Study for a Cost-Benefit Analysis.

ERIC Educational Resources Information Center

Scigliano, Marisa

2002-01-01

Discusses library cooperation and academic library consortia and presents a case study of a Canadian consortia that conducted a cost-benefit analysis for purchasing an electronic resource. Reports on member library subscription costs, external economic factors, value of patron time saved, costs and benefits for patrons, and net savings. (LRW)

The Effects of Perceived Quality on Behavioral Economic Demand for Marijuana: A Web-Based Experiment

PubMed Central

Vincent, Paula C.; Collins, R. Lorraine; Liu, Liu; Yu, Jihnhee; De Leo, Joseph A.; Earleywine, Mitch

2016-01-01

Background Given the growing legalization of recreational marijuana use and related increase in its prevalence in the United States, it is important to understand marijuana's appeal. We used a behavioral economic (BE) approach to examine whether the reinforcing properties of marijuana, including “demand” for marijuana, varied as a function of its perceived quality. Methods Using an innovative, Web-based marijuana purchase task (MPT), a sample of 683 young-adult recreational marijuana users made hypothetical purchases of marijuana across three qualities (low, mid and high grade) at nine escalating prices per joint, ranging from $0/free to $20. Results We used nonlinear mixed effects modeling to conduct demand curve analyses, which produced separate demand indices (e.g., Pmax, elasticity) for each grade of marijuana. Consistent with previous research, as the price of marijuana increased, marijuana users reduced their purchasing. Demand also was sensitive to quality, with users willing to pay more for higher quality/grade marijuana. In regression analyses, demand indices accounted for significant variance in typical marijuana use. Conclusions This study illustrates the value of applying BE theory to young adult marijuana use. It extends past research by examining how perceived quality affects demand for marijuana and provides support for the validity of a Web-based MPT to examine the appeal of marijuana. Our results have implications for policies to regulate marijuana use, including taxation based on the quality of different marijuana products. PMID:27951424

The effects of perceived quality on behavioral economic demand for marijuana: A web-based experiment.

PubMed

Vincent, Paula C; Collins, R Lorraine; Liu, Liu; Yu, Jihnhee; De Leo, Joseph A; Earleywine, Mitch

2017-01-01

Given the growing legalization of recreational marijuana use and related increase in its prevalence in the United States, it is important to understand marijuana's appeal. We used a behavioral economic (BE) approach to examine whether the reinforcing properties of marijuana, including "demand" for marijuana, varied as a function of its perceived quality. Using an innovative, Web-based marijuana purchase task (MPT), a sample of 683 young-adult recreational marijuana users made hypothetical purchases of marijuana across three qualities (low, mid and high grade) at nine escalating prices per joint, ranging from $0/free to $20. We used nonlinear mixed effects modeling to conduct demand curve analyses, which produced separate demand indices (e.g., P max , elasticity) for each grade of marijuana. Consistent with previous research, as the price of marijuana increased, marijuana users reduced their purchasing. Demand also was sensitive to quality, with users willing to pay more for higher quality/grade marijuana. In regression analyses, demand indices accounted for significant variance in typical marijuana use. This study illustrates the value of applying BE theory to young adult marijuana use. It extends past research by examining how perceived quality affects demand for marijuana and provides support for the validity of a Web-based MPT to examine the appeal of marijuana. Our results have implications for policies to regulate marijuana use, including taxation based on the quality of different marijuana products. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

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

Barzi, E.; Limon, P. J.; Yamada, R.

Fermilab is developing 11 T superconducting dipole magnets for future accelerators based on Nb/sub 3/Sn conductors. Multifilamentary Nb/sub 3/Sn strands 1 mm in diameter produced with the modified jelly roll and powder-in-tube technologies were purchased from OST and SMI respectively. They are herein fully characterized by I/sub c/, n-value, residual resistivity ratio, and magnetization. Results of heat treatment optimization studies are also presented for the OST strand.

Conjoint analysis: using a market-based research model for healthcare decision making.

PubMed

Mele, Nancy L

2008-01-01

Conjoint analysis is a market-based research model that has been used by businesses for more than 35 years to predict consumer preferences in product design and purchasing. Researchers in medicine, healthcare economics, and health policy have discovered the value of this methodology in determining treatment preferences, resource allocation, and willingness to pay. To describe the conjoint analysis methodology and explore value-added applications in nursing research. Conjoint analysis methodology is described, using examples from the healthcare and business literature, and personal experience with the method. Nurses are called upon to increase interdisciplinary research, provide an evidence base for nursing practice, create patient-centered treatments, and revise nursing education. Other disciplines have met challenges like these using conjoint analysis and discrete choice modeling.

Employment-based health insurance is failing: now what?

PubMed

Enthoven, Alain C

2003-01-01

Employment-based health insurance is failing. Costs are out of control. Employers have no effective strategy to deal with this. They must think strategically about fundamental change. This analysis explains how employers' purchasing policies contribute to rising costs and block growth of economical care. Single-source managed care is ineffective, and effective managed care cannot be a single source. Employers should create exchanges through which they can offer employees wide, responsible, individual, multiple choices among health care delivery systems and create serious competition based on value for money. Recently introduced technology can assist this process.

Impact of Standardized New Medication Education Program on Postdischarge Patients' Knowledge and Satisfaction.

PubMed

Jones, Tammie R; Coke, Lola

2016-10-01

This study, implemented on 2 medical-surgical units, evaluated the impact of a standardized, evidence-based new medication education program. Outcomes evaluated included patient postdischarge knowledge of new medication purpose and side effects, patient satisfaction with new medication, and Medicare reimbursement earn-back potential. As a result, knowledge scores for new medication purpose and side effects were high post intervention. Patient satisfaction with new medication education increased. Value-based purchasing reimbursement earn-back potential improved.

Multiple attribute decision making model and application to food safety risk evaluation.

PubMed

Ma, Lihua; Chen, Hong; Yan, Huizhe; Yang, Lifeng; Wu, Lifeng

2017-01-01

Decision making for supermarket food purchase decisions are characterized by network relationships. This paper analyzed factors that influence supermarket food selection and proposes a supplier evaluation index system based on the whole process of food production. The author established the intuitive interval value fuzzy set evaluation model based on characteristics of the network relationship among decision makers, and validated for a multiple attribute decision making case study. Thus, the proposed model provides a reliable, accurate method for multiple attribute decision making.

Drivers of choice for fluid milk versus plant-based alternatives: What are consumer perceptions of fluid milk?

PubMed

McCarthy, K S; Parker, M; Ameerally, A; Drake, S L; Drake, M A

2017-08-01

Fluid milk consumption has declined for decades while consumption of nondairy alternatives has increased. A better understanding of why consumers purchase fluid milk or nondairy alternatives is needed to assist increased sales of milk or maintain sales without further decline. The objective of this study was to determine the extrinsic attributes that drive purchase within each product category. The second objective was to determine the personal values behind the purchase of each beverage type to give further understanding why particular attributes are important. An online conjoint survey was launched with 702 dairy consumers, 172 nondairy consumers, and 125 consumers of both beverages. Individual means-end chain interviews were conducted with fluid milk consumers (n = 75), plant-based alternative consumers (n = 68), and consumers of both beverages (n = 78). Fat content was the most important attribute for dairy milk followed by package size and label claims. Consumers of fluid milk preferred 1 or 2% fat content, gallon, or half-gallon packaging, conventionally pasteurized store-brand milk. Sugar level was the most important attribute for plant-based beverages, followed by plant source and package size. Almond milk was the most desirable plant source, and half-gallon packaging was the most preferred packaging. Means-end chain interviews results suggested that maintaining a balanced diet and healthy lifestyle was important to all consumer groups. Lactose free was an important attribute for plant-based alternative consumers and consumers of both dairy and nondairy. A distinguishing characteristic of those who only drank nondairy plant-based alternatives was that plant-based beverages contributed to a goal to consume less animal products, beliefs about animal mistreatment, and perceived lesser effect on the environment than fluid milk. Unique to fluid milk consumers was that fluid milk was perceived as a staple food item. These results suggest that the dairy industry should focus on the nutrition value of milk and educating consumers about misconceptions regarding dairy milk. Future beverage innovation should include the development of lactose-free milk that is also appealing to consumers in flavor. Copyright © 2017 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

21 CFR 820.50 - Purchasing controls.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Purchasing controls. 820.50 Section 820.50 Food... DEVICES QUALITY SYSTEM REGULATION Purchasing Controls § 820.50 Purchasing controls. Each manufacturer... control to be exercised over the product, services, suppliers, contractors, and consultants, based on the...

21 CFR 820.50 - Purchasing controls.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Purchasing controls. 820.50 Section 820.50 Food... DEVICES QUALITY SYSTEM REGULATION Purchasing Controls § 820.50 Purchasing controls. Each manufacturer... control to be exercised over the product, services, suppliers, contractors, and consultants, based on the...

21 CFR 820.50 - Purchasing controls.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Purchasing controls. 820.50 Section 820.50 Food... DEVICES QUALITY SYSTEM REGULATION Purchasing Controls § 820.50 Purchasing controls. Each manufacturer... control to be exercised over the product, services, suppliers, contractors, and consultants, based on the...

21 CFR 820.50 - Purchasing controls.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Purchasing controls. 820.50 Section 820.50 Food... DEVICES QUALITY SYSTEM REGULATION Purchasing Controls § 820.50 Purchasing controls. Each manufacturer... control to be exercised over the product, services, suppliers, contractors, and consultants, based on the...

21 CFR 820.50 - Purchasing controls.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Purchasing controls. 820.50 Section 820.50 Food... DEVICES QUALITY SYSTEM REGULATION Purchasing Controls § 820.50 Purchasing controls. Each manufacturer... control to be exercised over the product, services, suppliers, contractors, and consultants, based on the...

Some "Thing" to Talk About? Differential Story Utility From Experiential and Material Purchases.

PubMed

Kumar, Amit; Gilovich, Thomas

2015-10-01

Psychological research has shown that experiential purchases (a hike in the woods, a trip to Rome) bring more happiness than material purchases (a designer shirt, a flat-screen television). The research presented in this article investigates one cause and consequence of this difference: People talk more about their experiences than their possessions and derive more value from doing so. A series of eight studies demonstrate that taking away the ability to talk about experiences (but not material goods) would diminish the enjoyment they bring; that people believe they derive more happiness from talking about experiential purchases; that when given a choice about which of their purchases to talk about, people are more likely to talk about experiential rather than material consumption; and that people report being more inclined to talk about their experiences than their material purchases and derive more hedonic benefits as a result--both in prospect and in retrospect. © 2015 by the Society for Personality and Social Psychology, Inc.

Buying best value health care: Evolution of purchasing among Australian private health insurers

PubMed Central

Willcox, Sharon

2005-01-01

Since 1995 Australian health insurers have been able to purchase health services pro-actively through negotiating contracts with hospitals, but little is known about their experience of purchasing. This paper examines the current status of purchasing through interviews with senior managers representing all Australian private health insurers. Many of the traditional tools used to generate competition and enhance efficiency (such as selective contracting and co-payments) have had limited use due to public and political opposition. Adoption of bundled case payment models using diagnosis related groups (DRGs) has been slow. Insurers cite multiple reasons including poor understanding of private hospital costs, unfamiliarity with DRGs, resistance from the medical profession and concerns about premature discharge. Innovation in payment models has been limited, although some insurers are considering introduction of volume-outcome purchasing and pay for performance incentives. Private health insurers also face a complex web of regulation, some of which appears to impede moves towards more efficient purchasing. PMID:15801982

30 CFR 206.257 - Valuation standards for ad valorem leases.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., were not part of the total consideration paid for the purchase of coal production. (c)(1) The value of... with the lessee for sales, purchases, or other dispositions of like-quality coal produced in the area... following factors shall be considered: Price, time of execution, duration, market or markets served, terms...

25 CFR 900.93 - When may the Secretary elect to acquire title to contractor-purchased property?

Code of Federal Regulations, 2013 CFR

2013-04-01

... SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Property Donation Procedures Contractor-Purchased...) Except as provided in paragraph (b) of this section when a self-determination contract or grant agreement... a current fair market value, less the cost of improvements borne by the Indian tribe or tribal...

25 CFR 900.93 - When may the Secretary elect to acquire title to contractor-purchased property?

Code of Federal Regulations, 2014 CFR

2014-04-01

... SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Property Donation Procedures Contractor-Purchased...) Except as provided in paragraph (b) of this section when a self-determination contract or grant agreement... a current fair market value, less the cost of improvements borne by the Indian tribe or tribal...

25 CFR 900.93 - When may the Secretary elect to acquire title to contractor-purchased property?

Code of Federal Regulations, 2010 CFR

2010-04-01

... SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Property Donation Procedures Contractor-Purchased...) Except as provided in paragraph (b) of this section when a self-determination contract or grant agreement... a current fair market value, less the cost of improvements borne by the Indian tribe or tribal...

25 CFR 900.93 - When may the Secretary elect to acquire title to contractor-purchased property?

Code of Federal Regulations, 2012 CFR

2012-04-01

... SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Property Donation Procedures Contractor-Purchased...) Except as provided in paragraph (b) of this section when a self-determination contract or grant agreement... a current fair market value, less the cost of improvements borne by the Indian tribe or tribal...

25 CFR 900.93 - When may the Secretary elect to acquire title to contractor-purchased property?

Code of Federal Regulations, 2011 CFR

2011-04-01

... SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Property Donation Procedures Contractor-Purchased...) Except as provided in paragraph (b) of this section when a self-determination contract or grant agreement... a current fair market value, less the cost of improvements borne by the Indian tribe or tribal...

The Questionable Economic Case for Value-Based Drug Pricing in Market Health Systems.

PubMed

Pauly, Mark V

2017-02-01

This article investigates the economic theory and interpretation of the concept of "value-based pricing" for new breakthrough drugs with no close substitutes in a context (such as the United States) in which a drug firm with market power sells its product to various buyers. The interpretation is different from that in a country that evaluates medicines for a single public health insurance plan or a set of heavily regulated plans. It is shown that there will not ordinarily be a single value-based price but rather a schedule of prices with different volumes of buyers at each price. Hence, it is incorrect to term a particular price the value-based price, or to argue that the profit-maximizing monopoly price is too high relative to some hypothesized value-based price. When effectiveness of treatment or value of health is heterogeneous, the profit-maximizing price can be higher than that associated with assumed values of quality-adjusted life-years. If the firm sets a price higher than the value-based price for a set of potential buyers, the optimal strategy of the buyers is to decline to purchase that drug. The profit-maximizing price will come closer to a unique value-based price if demand is less heterogeneous. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Expected value based fuzzy programming approach to solve integrated supplier selection and inventory control problem with fuzzy demand

NASA Astrophysics Data System (ADS)

Sutrisno; Widowati; Sunarsih; Kartono

2018-01-01

In this paper, a mathematical model in quadratic programming with fuzzy parameter is proposed to determine the optimal strategy for integrated inventory control and supplier selection problem with fuzzy demand. To solve the corresponding optimization problem, we use the expected value based fuzzy programming. Numerical examples are performed to evaluate the model. From the results, the optimal amount of each product that have to be purchased from each supplier for each time period and the optimal amount of each product that have to be stored in the inventory for each time period were determined with minimum total cost and the inventory level was sufficiently closed to the reference level.

The economic consequences of neurosurgical disease in low- and middle-income countries.

PubMed

Rudolfson, Niclas; Dewan, Michael C; Park, Kee B; Shrime, Mark G; Meara, John G; Alkire, Blake C

2018-05-18

OBJECTIVE The objective of this study was to estimate the economic consequences of neurosurgical disease in low- and middle-income countries (LMICs). METHODS The authors estimated gross domestic product (GDP) losses and the broader welfare losses attributable to 5 neurosurgical disease categories in LMICs using two distinct economic models. The value of lost output (VLO) model projects annual GDP losses due to neurosurgical disease during 2015-2030, and is based on the WHO's "Projecting the Economic Cost of Ill-health" tool. The value of lost economic welfare (VLW) model estimates total welfare losses, which is based on the value of a statistical life and includes nonmarket losses such as the inherent value placed on good health, resulting from neurosurgical disease in 2015 alone. RESULTS The VLO model estimates the selected neurosurgical diseases will result in $4.4 trillion (2013 US dollars, purchasing power parity) in GDP losses during 2015-2030 in the 90 included LMICs. Economic losses are projected to disproportionately affect low- and lower-middle-income countries, risking up to a 0.6% and 0.54% loss of GDP, respectively, in 2030. The VLW model evaluated 127 LMICs, and estimates that these countries experienced $3 trillion (2013 US dollars, purchasing power parity) in economic welfare losses in 2015. Regardless of the model used, the majority of the losses can be attributed to stroke and traumatic brain injury. CONCLUSIONS The economic impact of neurosurgical diseases in LMICs is significant. The magnitude of economic losses due to neurosurgical diseases in LMICs provides further motivation beyond already compelling humanitarian reasons for action.

Grid-connected distributed solar power systems

NASA Astrophysics Data System (ADS)

Moyle, R.; Chernoff, H.; Schweizer, T.

This paper discusses some important, though often ignored, technical and economic issues of distributed solar power systems: protection of the utility system and nonsolar customers requires suitable interfaced equipment. Purchase criteria must mirror reality; most analyses use life-cycle costing with low discount rates - most buyers use short payback periods. Distributing, installing, and marketing small, distributed solar systems is more costly than most analyses estimate. Results show that certain local conditions and uncommon purchase considerations can combine to make small, distributed solar power attractive, but lower interconnect costs (per kW), lower marketing and product distribution costs, and more favorable purchase criteria make large, centralized solar energy more attractive. Specifically, the value of dispersed solar systems to investors and utilities can be higher than $2000/kw. However, typical residential owners place a value of well under $1000 on the installed system.

76 FR 51933 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-19

... that the Forest Service (FS) establish a process by which purchasers may appeal decisions concerning... program is designed to ensure that small business timber purchasers have the opportunity to purchase a... businesses every five years based on the actual volume of saw timber purchased by small businesses...

Further Validation of a Marijuana Purchase Task

PubMed Central

Aston, Elizabeth R.; Metrik, Jane; MacKillop, James

2015-01-01

Background A valid measure of the relative economic value of marijuana is needed to characterize individual variation in the drug’s reinforcing value and inform evolving national marijuana policy. Relative drug value (demand) can be measured via purchase tasks, and demand for alcohol and cigarettes has been associated with craving, dependence, and treatment response. This study examined marijuana demand with a marijuana purchase task (MPT). Methods The 22-item self-report MPT was administered to 99 frequent marijuana users (37.4% female, 71.5% marijuana use days, 15.2% cannabis dependent). Results Pearson correlations indicated a negative relationship between intensity (free consumption) and age of initiation of regular use (r=−0.34, p<0.001), and positive associations with use days (r=0.26, p<0.05) and subjective craving (r=0.43, p<0.001). Omax (maximum expenditure) was positively associated with use days (r=0.29, p<0.01) and subjective craving (r=0.27, p<0.01). Income was not associated with demand. An exponential demand model provided an excellent fit to the data across users (R2=0.99). Group comparisons based on presence or absence of DSM-IV cannabis dependence symptoms revealed that users with any dependence symptoms showed significantly higher intensity of demand and more inelastic demand, reflecting greater insensitivity to price increases. Conclusions These results provide support for construct validity of the MPT, indicating its sensitivity to marijuana demand as a function of increasing cost, and its ability to differentiate between users with and without dependence symptoms. The MPT may denote abuse liability and is a valuable addition to the behavioral economic literature. Potential applications to marijuana pricing and tax policy are discussed. PMID:26002377

Sociodemographic Factors Differentiating the Consumer and the Motivations for Functional Food Consumption.

PubMed

Kraus, Artur; Annunziata, Azzurra; Vecchio, Riccardo

2017-02-01

The aim of this study was to determine the (1) role of gender, age, and education in the evaluation of multidimensional criteria of the purchase of functional products, which were (a) quality and organoleptic attributes, (b) attributes of packaging and labeling, (c) healthful properties, (d) functional components, (e) base product (carrier) and (2) most important motives for the purchase and consumption of functional food among consumers of different sociodemographic profiles. The data were collected in direct interviews. The sample (n = 200) consisted of 137 women and 63 men age 18-60 years. The research tool was a questionnaire divided into 4 sections. The first one included quality attributes. The second one included healthful properties, functional components, and carriers. The third one concerned the motives for purchasing functional food and included the consequences and values. In the fourth section the participants were asked about gender, age, and education. Gender, age, and education differentiated the criteria influencing the decision to purchase functional food. Women, older people (35-60 years), and those with university education attach the greatest importance to naturalness, nutritional value, freshness, food safety, and quality guarantee. Clear differences between men and women appear in the field of functional components, which are significantly more important for women than for men. Gender, age, and education essentially differentiate the preferences for base product (carrier). Young men prefer meat products in the role of functional carriers. In turn, women and older men prefer cereal products as basic functional carriers. Young consumers are more open to high-technology food processing. Motivations are differentiated by age and gender. Young men, as opposed to women and older men, attach less importance to functional and psychological consequences: improvement of health, healthy eating, conscious choice, and health promotion. Women and older men are more interested in health safety and are more responsible for their health. Among young men, lower self-esteem can be found. The analysis conducted revealed that groups of consumers are significantly different from each other in the evaluation of the significance of each of the variables in the selection of functional food. Sociodemographic factors differentiate the motivations for consumption of functional food.

WTP for a QALY and health states: More money for severer health states?

PubMed Central

2013-01-01

Background In economic evaluation, cost per quality-adjusted life year (QALY) is generally used as an indicator for cost-effectiveness. Although JPY 5 million to 6 million (USD 60, 000 to 75,000) per QALY is frequently referred to as a threshold in Japan, do all QALYs have the same monetary value? Methods To examine the relationship between severity of health status and monetary value of a QALY, we obtained willingness to pay (WTP) values for one additional QALY in eight patterns of health states. We randomly sampled approximately 2,400 respondents from an online panel. To avoid misunderstanding, we randomly allocated respondents to one of 16 questionnaires, with 250 responses expected for each pattern. After respondents were asked whether they wanted to purchase the treatment, double-bounded dichotomous choice method was used to obtain WTP values. Results The results clearly show that the WTP per QALY is higher for worse health states than for better health states. The slope was about JPY −1 million per 0.1 utility score increase. The mean and median WTP values per QALY for 16 health states were JPY 5 million, consistent with our previous survey. For respondents who wanted to purchase the treatment, WTP values were significantly correlated with household income. Conclusion This survey shows that QALY based on the EQ-5D does not necessarily have the same monetary value. The WTP per QALY should range from JPY 2 million (USD 20,000) to JPY 8 million (USD 80,000), corresponding to the severity of health states. PMID:24128004

WTP for a QALY and health states: More money for severer health states?

PubMed

Shiroiwa, Takeru; Igarashi, Ataru; Fukuda, Takashi; Ikeda, Shunya

2013-01-01

In economic evaluation, cost per quality-adjusted life year (QALY) is generally used as an indicator for cost-effectiveness. Although JPY 5 million to 6 million (USD 60, 000 to 75,000) per QALY is frequently referred to as a threshold in Japan, do all QALYs have the same monetary value? To examine the relationship between severity of health status and monetary value of a QALY, we obtained willingness to pay (WTP) values for one additional QALY in eight patterns of health states. We randomly sampled approximately 2,400 respondents from an online panel. To avoid misunderstanding, we randomly allocated respondents to one of 16 questionnaires, with 250 responses expected for each pattern. After respondents were asked whether they wanted to purchase the treatment, double-bounded dichotomous choice method was used to obtain WTP values. The results clearly show that the WTP per QALY is higher for worse health states than for better health states. The slope was about JPY -1 million per 0.1 utility score increase. The mean and median WTP values per QALY for 16 health states were JPY 5 million, consistent with our previous survey. For respondents who wanted to purchase the treatment, WTP values were significantly correlated with household income. This survey shows that QALY based on the EQ-5D does not necessarily have the same monetary value. The WTP per QALY should range from JPY 2 million (USD 20,000) to JPY 8 million (USD 80,000), corresponding to the severity of health states.

Medicare and Medicaid Programs; CY 2018 Home Health Prospective Payment System Rate Update and CY 2019 Case-Mix Adjustment Methodology Refinements; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements. Final rule.

PubMed

2017-11-07

This final rule updates the home health prospective payment system (HH PPS) payment rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor, effective for home health episodes of care ending on or after January 1, 2018. This rule also: Updates the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking; implements the third year of a 3-year phase-in of a reduction to the national, standardized 60-day episode payment to account for estimated case-mix growth unrelated to increases in patient acuity (that is, nominal case-mix growth) between calendar year (CY) 2012 and CY 2014; and discusses our efforts to monitor the potential impacts of the rebasing adjustments that were implemented in CY 2014 through CY 2017. In addition, this rule finalizes changes to the Home Health Value-Based Purchasing (HHVBP) Model and to the Home Health Quality Reporting Program (HH QRP). We are not finalizing the implementation of the Home Health Groupings Model (HHGM) in this final rule.

Orthopedic Implant Value Drivers: A Qualitative Survey Study of Hospital Purchasing Administrators.

PubMed

Li, Chuan Silvia; Vannabouathong, Christopher; Sprague, Sheila; Bhandari, Mohit

2015-01-01

Osteoarthritis (OA) is a chronic, degenerative disease that is highly prevalent in the population, yet the factors that affect purchasing decisions related to this condition are poorly understood. A questionnaire was developed and administered to hospital executives across North America to determine the factors that affect purchasing decisions related to OA. Thirty-four individuals participated in the survey. Clinical evidence and cost effectiveness were deemed to be the most important factors in the process of making purchasing decisions. The most important considerations for adopting new technology were whether there was sufficient evidence in the literature, followed by thoughts of key opinion leaders, and cost of intervention/device. Ongoing research is still needed, but the current study allowed us to identify some trends in the data, providing new insight on how hospital purchasing decisions are made, which could have an immediate impact on those currently involved with making these decisions.

Economic evaluation of price discounts and skill-building strategies on purchase and consumption of healthy food and beverages: The SHELf randomized controlled trial.

PubMed

Le, Ha N D; Gold, Lisa; Abbott, Gavin; Crawford, David; McNaughton, Sarah A; Mhurchu, Cliona Ni; Pollard, Christina; Ball, Kylie

2016-06-01

Pricing strategies are a promising approach for promoting healthier dietary choices. However, robust evidence of the cost-effectiveness of pricing manipulations on dietary behaviour is limited. We aimed to assess the cost-effectiveness of a 20% price reduction on fruits and vegetables and a combined skills-based behaviour change and price reduction intervention. Cost-effectiveness analysis from a societal perspective was undertaken for the randomized controlled trial Supermarket Healthy Eating for Life (SHELf). Female shoppers in Melbourne, Australia were randomized to: (1) skill-building (n = 160); (2) price reductions (n = 161); (3) combined skill-building and price reduction (n = 161); or (4) control group (n = 161). The intervention was implemented for three months followed by a six month follow-up. Costs were measured in 2012 Australian dollars. Fruit and vegetable purchasing and consumption were measured in grams/week. At three months, compared to control participants, price reduction participants increased vegetable purchases by 233 g/week (95% CI 4 to 462, p = 0.046) and fruit purchases by 364 g/week (95% CI 95 to 633, p = 0.008). Participants in the combined group purchased 280 g/week more fruits (95% CI 27 to 533, p = 0.03) than participants in the control group. Increases were not maintained six-month post intervention. No effect was noticed in the skill-building group. Compared to the control group, the price reduction intervention cost an additional A$2.3 per increased serving of vegetables purchased per week or an additional A$3 per increased serving of fruit purchased per week. The combined intervention cost an additional A$12 per increased serving of fruit purchased per week compared to the control group. A 20% discount on fruits and vegetables was effective in promoting overall fruit and vegetable purchases during the period the discount was active and may be cost-effective. The price discount program gave better value for money than the combined price reduction and skill-building intervention. The SHELf trial is registered with Current Controlled Trials Registration ISRCTN39432901. Copyright © 2016 Elsevier Ltd. All rights reserved.

Do high vs. low purchasers respond differently to a nonessential energy-dense food tax? Two-year evaluation of Mexico's 8% nonessential food tax.

PubMed

Taillie, Lindsey Smith; Rivera, Juan A; Popkin, Barry M; Batis, Carolina

2017-12-01

It is unclear whether response to a nonessential food tax varies across time or for high vs. low-consuming households. The objective is to examine whether the effect of Mexico's 2014 8% nonessential energy-dense foods tax increased in the second year post-implementation and whether it differentially affected households by pre-tax purchasing pattern. We used longitudinal data on Mexican household food purchases (n=6089 households) from 2012 to 2015. Households were classified based on median pre-tax purchases: low untaxed/low taxed ("low"), low untaxed/high taxed ("unhealthy"), high untaxed/low taxed ("healthy"), and high untaxed/high taxed ("high") purchasers. Fixed effects models tested whether observed post-tax purchases differed from the counterfactual, or what would have been expected based on pre-tax trends. Post-tax declines in the % taxed food purchases increased from -4.8% in year one to -7.4% in year two, yielding a 2-year mean decline of 6.0% beyond the counterfactual (p<0.01). Post-tax change in % taxed food purchases varied by pre-tax purchasing level. Healthy purchasers showed no post-tax change in % taxed food purchases beyond the counterfactual, while unhealthy, low and high purchasers decreased (-12.3%, -5.3% and -4.4%, respectively) (p<0.01). The positive effect of Mexico's junk food tax continued in the second year, and households with greater preferences for taxed foods showed a larger decline in taxed food purchases. Copyright © 2017 Elsevier Inc. All rights reserved.

Emerging lessons from regional and state innovation in value-based payment reform: balancing collaboration and disruptive innovation.

PubMed

Conrad, Douglas A; Grembowski, David; Hernandez, Susan E; Lau, Bernard; Marcus-Smith, Miriam

2014-09-01

In recent decades, practitioners and policymakers have turned to value-based payment initiatives to help contain spending on health care and to improve the quality of care. The Robert Wood Johnson Foundation funded 7 grantees across the country to design and implement value-based, multistakeholder payment reform projects in 6 states and 3 regions of the United States. As the external evaluator of these projects, we reviewed documents, conducted Internet searches, interviewed key stakeholders, cross-validated factual and narrative interpretation, and performed qualitative analyses to derive cross-site themes and implications for policy and practice. The nature of payment reform and its momentum closely reflects the environmental context of each project. Federal legislation such as the Patient Protection and Affordable Care Act and federal and state support for the development of the patient-centered medical home and accountable care organizations encourage value-based payment innovation, as do local market conditions for payers and providers that combine a history of collaboration with independent innovation and experimentation by individual organizations. Multistakeholder coalitions offer a useful facilitating structure for galvanizing payment reform. But to achieve the objectives of reduced cost and improved quality, multistakeholder payment innovation must overcome such barriers as incompatible information systems, the technical difficulties and transaction costs of altering existing billing and payment systems, competing stakeholder priorities, insufficient scale to bear population health risk, providers' limited experience with risk-bearing payment models, and the failure to align care delivery models with the form of payment. From the evidence adduced in this article, multistakeholder, value-based payment reform requires a trusted, widely respected "honest broker" that can convene and maintain the ongoing commitment of health plans, providers, and purchasers. Change management is complex and challenging, and coalition governance requires flexibility and stable leadership, as market conditions and stakeholder engagement and priorities shift over time. Another significant facilitator of value-based payment reform is outside investment that enables increased investment in human resources, information infrastructure, and care management by provider organizations and their collaborators. Supportive community and social service networks that enhance population health management also are important enablers of value-based payment reform. External pressure from public and private payers is fueling a "burning bridge" between the past of fee-for-service payment models and the future of payments based on value. Robust competition in local health plan and provider markets, coupled with an appropriate mix of multistakeholder governance, pressure from organized purchasers, and regulatory oversight, has the potential to spur value-based payment innovation that combines elements of "reformed" fee-for-service with bundled payments and global payments. © 2014 Milbank Memorial Fund.

Neural Insensitivity to Upticks in Value is Associated with the Disposition Effect

PubMed Central

Brooks, Andrew M.; Capra, C. Monica; Berns, Gregory S.

2011-01-01

The disposition effect is a phenomenon in which investors hold onto losing assets longer than they hold onto gaining assets. In this study, we used functional magnetic resonance imaging (fMRI) to measure the response of valuation regions in the brain during the decision to keep or to sell an asset that followed a random walk in price. The most common explanation for the disposition effect is preference-based: namely, that people are risk-averse over gains and risk-seeking over losses. This explanation would predict correlations between individuals’ risk-preferences, the magnitude of their disposition effect, and activation in valuation structures of the brain. We did not observe these correlations. Nor did we find evidence for a realization utility explanation, which would predict differential responses in valuation regions during the decision to sell versus keep an asset that correlated with the magnitude of the disposition effect. Instead, we found an attenuated ventral striatum response to upticks in value below the purchase price in some individuals with a large disposition effect. Given the role of the striatum in signaling prediction error, the blunted striatal response is consistent with the expectation that an asset will rise when it is below the purchase price, thus spurring loss-holding behavior. This suggests that for some individuals, the disposition effect is likely driven by a belief that the asset will eventually return to the purchase price, also known as mean reversion. PMID:22079448

The Viability of Lease Purchases as a Means for Funding School Facilities.

ERIC Educational Resources Information Center

Bunch, Beverly S.; Smith, Tina

2002-01-01

Examines the use of the lease purchase of school facilities in Texas; provides background on the use of lease purchases by Texas school districts; describes factors influencing the use of lease purchases and superintendents' experiences based on survey responses from 50 school districts; recommends careful evaluation of advantages and…

12 CFR 563b.650 - What must I include in my plan of voluntary supervisory conversion?

Code of Federal Regulations, 2010 CFR

2010-01-01

... purchaser of conversion shares and a description of that purchaser's relationship to you. (c) The title, per-unit par value, number, and per-unit and aggregate offering price of shares that you will issue. (d... OF THE TREASURY CONVERSIONS FROM MUTUAL TO STOCK FORM Voluntary Supervisory Conversions Plan of...

26 CFR 25.2702-4 - Certain property treated as held in trust.

Code of Federal Regulations, 2014 CFR

2014-04-01

... child purchases the remainder interest in the property. A and A's child each provide the portion of the... transferring the remainder interest to A's child in exchange for the portion of the purchase price provided by A's child. In determining the amount of A's gift, A's retained interest is valued at zero because it...

26 CFR 25.2702-4 - Certain property treated as held in trust.

Code of Federal Regulations, 2013 CFR

2013-04-01

... child purchases the remainder interest in the property. A and A's child each provide the portion of the... transferring the remainder interest to A's child in exchange for the portion of the purchase price provided by A's child. In determining the amount of A's gift, A's retained interest is valued at zero because it...

26 CFR 25.2702-4 - Certain property treated as held in trust.

Code of Federal Regulations, 2012 CFR

2012-04-01

... child purchases the remainder interest in the property. A and A's child each provide the portion of the... transferring the remainder interest to A's child in exchange for the portion of the purchase price provided by A's child. In determining the amount of A's gift, A's retained interest is valued at zero because it...

26 CFR 25.2702-4 - Certain property treated as held in trust.

Code of Federal Regulations, 2011 CFR

2011-04-01

... child purchases the remainder interest in the property. A and A's child each provide the portion of the... transferring the remainder interest to A's child in exchange for the portion of the purchase price provided by A's child. In determining the amount of A's gift, A's retained interest is valued at zero because it...

19 CFR 10.17 - Valuation of exempted components.

Code of Federal Regulations, 2010 CFR

2010-04-01

... components when last purchased, f.o.b. United States port of exportation or point of border crossing as set out in the invoice and entry papers, or, if no purchase was made, the value of the components at the time of their shipment for exportation, f.o.b. United States port of exportation or point of border...

The influence of ethical values and food choice motivations on intentions to purchase sustainably sourced foods.

PubMed

Dowd, Kylie; Burke, Karena J

2013-10-01

This study examined a three-step adaptation of the Theory of Planned Behaviour (TPB) applied to the intention of consumers to purchase sustainably sourced food. The sample consisted of 137 participants, of which 109 were female, who were recruited through a farmers market and an organic produce outlet in an Australian capital city. Participants completed an online questionnaire containing the TPB scales of attitude, subjective norms, perceived behavioural control and intention; measures of positive moral attitude and ethical self identity; and food choice motives. Hierarchical multiple regression was used to examine the predictive utility of the TPB in isolation (step 1) and the TPB expanded to include the constructs of moral attitude and ethical self-identity (step 2). The results indicated the expansion of the TPB to include these constructs added significantly to the predictive model measuring intention to purchase sustainably sourced food. The third step in the adaptation utilised this expanded TPB model and added a measure of retail channel (where consumers reported buying fresh produce) and 9 food choice motives, in order to assess the predictive utility of the inclusion of choice motivations in this context. Of the 8 food choice motives examined, only health and ethical values significantly predicted intention to purchase sustainably sourced food. However, with the addition of food choice motives, ethical self-identity was no longer a significant predictor of intention to purchase sustainably sourced food. Overall the adapted TPB model explained 76% of the variance in intention to purchase sustainably sourced food. Copyright © 2013 Elsevier Ltd. All rights reserved.

Ecolabeled paper towels: consumer valuation and expenditure analysis.

PubMed

Srinivasan, Arun K; Blomquist, Glenn C

2009-01-01

Ecolabeled paper towels are manufactured using post-consumer recycled material and sold in markets using a recycle logo. Environmentally conscious consumers purchase these paper towels and thereby contribute to improving environmental quality. In this paper, we estimate the implicit value placed by consumers on ecolabeled paper towels using a hedonic price function and conduct an expenditure analysis using Heckman's selection model. Using the data set from the Internet-based grocery stores called as Peapod we find that some consumers recognize ecolabels on paper towels and place a substantial, positive price premium on them. The expenditure analysis indicates that for the preferred functional form, the demand for ecolabeled paper towels is inelastic for environmentally conscious consumers. The simulated results from the selection model indicate that a small subsidy for ecolabeled paper towels will not substantially change consumers' purchase decisions.

32 CFR 37.705 - What standards do I include for purchasing systems of for-profit firms?

Code of Federal Regulations, 2010 CFR

2010-07-01

... include for purchasing systems of for-profit firms? (a) If your TIA is an expenditure-based award, it... the purchasing standards in 32 CFR 34.31 to use the same requirements for TIAs, unless there are...). (b) You should allow other for-profit participants under expenditure-based TIAs to use their existing...

Call-Center Based Disease Management of Pediatric Asthmatics

DTIC Science & Technology

2005-04-01

study locations. Purchase peak flow meters. Prepare and reproduce patient education materials, and informed consent work sheets. Contract Oracle data...identified. Electronic peak flow meters have been purchased. Patient education materials and informed consent documents have been reproduced. A web-based...Research Center * Study population identified via military and Foundation Health databases * Electronic peak flow meters purchased * Patient education materials

10 CFR 603.700 - Standards for purchasing systems of for-profit firms.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Purchasing § 603.700 Standards for purchasing systems of for-profit firms. (a) If the TIA is an expenditure... instruments subject to the purchasing standards in 10 CFR 600.331 to use the same requirements for the TIA... documented in the award file). (b) Other for-profit participants under an expenditure-based TIA should be...

Using rewards-based incentives to increase purchase of fruit and vegetables in lower-income households: design and start-up of a randomized trial.

PubMed

Phipps, Etienne J; Wallace, Samantha L; Stites, Shana D; Uplinger, Nadine; Brook Singletary, S; Hunt, Lacy; Axelrod, Saul; Glanz, Karen; Braitman, Leonard E

2013-05-01

To report the design and baseline results of a rewards-based incentive to promote purchase of fruit and vegetables by lower-income households. A four-phase randomized trial with wait-listed controls. In a pilot study, despite inadequate study coupon use, purchases of fresh fruit (but not vegetables) increased, but with little maintenance. In the present study, credits on the study store gift card replace paper coupons and a tapering phase is added. The primary outcome is the number of servings of fresh and frozen fruit and vegetables purchased per week. A large full-service supermarket located in a predominantly minority community in Philadelphia, Pennsylvania, USA. Fifty-eight households, with at least one child living in the home. During the baseline period, households purchased an average of 3·7 servings of fresh vegetables and an average of less than 1 serving of frozen vegetables per week. Households purchased an average of 1·9 servings of fresh fruit per week, with little to no frozen fruit purchases. Overall, the range of fresh and frozen produce purchased during this pre-intervention period was limited. At baseline, produce purchases were small and of limited variety. The study will contribute to understanding the impact of financial incentives on increasing the purchases of healthier foods by lower-income populations.

Alternative Fuels Data Center

Science.gov Websites

fleets to provide grants for the purchase or lease of a new vehicle and the purchase, lease, or based on the incremental costs associated with the purchase or lease of different categories of motor

The Impact of Nutrition Standards on Competitive Food Offerings and Purchasing Behaviors of High School Students

ERIC Educational Resources Information Center

Snelling, Anastasia M.; Kennard, Teha

2009-01-01

Background: With adolescent obesity rates on the rise, the school food environment is receiving closer scrutiny. This study looks at the effects of nutrient standards as part of a wellness policy that was implemented in 3 public high schools in 1 county, by analyzing the nutritional value of competitive food offerings and purchases before and…

7 CFR 1901.508 - Servicing of insured notes outstanding with investors.

Code of Federal Regulations, 2010 CFR

2010-01-01

... its successor agency under Public Law 103-354 to purchase an insured note. (4) Price. If FmHA or its successor agency under Public Law 103-354 is the buyer of an insured note, the price will be the par value... recommendation by the State Director that purchase of an insured note is necessary for any servicing action not...

17 CFR 230.144 - Persons deemed not to be engaged in a distribution and therefore not underwriters.

Code of Federal Regulations, 2011 CFR

2011-04-01

... fair market value at least equal to the purchase price of the securities purchased; and (iii) Shall... broker or the date of execution of the transaction directly with a market maker, or (iii) The average... or an effective national market system plan as those terms are defined in § 242.600 of this chapter...

17 CFR 230.144 - Persons deemed not to be engaged in a distribution and therefore not underwriters.

Code of Federal Regulations, 2014 CFR

2014-04-01

... fair market value at least equal to the purchase price of the securities purchased; and (iii) Shall... broker or the date of execution of the transaction directly with a market maker, or (iii) The average... or an effective national market system plan as those terms are defined in § 242.600 of this chapter...

17 CFR 230.144 - Persons deemed not to be engaged in a distribution and therefore not underwriters.

Code of Federal Regulations, 2012 CFR

2012-04-01

... fair market value at least equal to the purchase price of the securities purchased; and (iii) Shall... broker or the date of execution of the transaction directly with a market maker, or (iii) The average... or an effective national market system plan as those terms are defined in § 242.600 of this chapter...

17 CFR 230.144 - Persons deemed not to be engaged in a distribution and therefore not underwriters.

Code of Federal Regulations, 2013 CFR

2013-04-01

... fair market value at least equal to the purchase price of the securities purchased; and (iii) Shall... broker or the date of execution of the transaction directly with a market maker, or (iii) The average... or an effective national market system plan as those terms are defined in § 242.600 of this chapter...

Outcomes of a randomized controlled trial of nutrition education to promote farmers' market fruit and vegetable purchases and consumption among women enrolled in the Special Supplemental Nutrition Program for Women, Infants,

USDA-ARS?s Scientific Manuscript database

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides participants seasonal Farmers' Market Nutrition Program (FMNP) vouchers to purchase fruits and vegetables (FV) at farmers' markets and monthly cash value vouchers (CVV) redeemable at farmers' markets. Despite ...

Estimating the monetary value of willingness to pay for E-book reader's attributes using partially confounded factorial conjoint choice experiment

NASA Astrophysics Data System (ADS)

Yong, Chin-Khian

2013-09-01

A partially confounded factorial conjoint choice experiments design was used to examine the monetary value of the willingness to pay for E-book Reader's attributes. Conjoint analysis is an efficient, cost-effective, and most widely used quantitative method in marketing research to understand consumer preferences and value trade-off. Value can be interpreted by customer or consumer as the received of multiple benefits from a price that was paid. The monetary value of willingness to pay for battery life, internal memory, external memory, screen size, text to Speech, touch screen, and converting handwriting to digital text of E-book reader were estimated in this study. Due to the significant interaction effect of the attributes with the price, the monetary values for the seven attributes were found to be different at different values of odds of purchasing versus not purchasing. The significant interactions effects were one of the main contribution of the partially confounded factorial conjoint choice experiment.

Food and beverage purchases in corner stores, gas-marts, pharmacies and dollar stores.

PubMed

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

2017-10-01

Little is known about customer purchases of foods and beverages from small and non-traditional food retailers (i.e. corner stores, gas-marts, dollar stores and pharmacies). The present study aimed to: (i) describe customer characteristics, shopping frequency and reasons for shopping at small and non-traditional food retailers; and (ii) describe food/beverage purchases and their nutritional quality, including differences across store type. Data were collected through customer intercept interviews. Nutritional quality of food/beverage purchases was analysed; a Healthy Eating Index-2010 (HEI-2010) score for purchases was created by aggregating participant purchases at each store. Small and non-traditional food stores that were not WIC-authorized in Minneapolis and St. Paul, MN, USA. Customers (n 661) from 105 food retailers. Among participants, 29 % shopped at the store at least once daily; an additional 44 % shopped there at least once weekly. Most participants (74 %) cited convenient location as the primary draw to the store. Customers purchased a median of 2262 kJ (540 kcal), which varied by store type (P=0·04). The amount of added sugar far surpassed national dietary recommendations. At dollar stores, participants purchased a median of 5302 kJ (1266 kcal) for a median value of $US 2·89. Sugar-sweetened beverages were the most common purchase. The mean HEI-2010 score across all stores was 36·4. Small and non-traditional food stores contribute to the urban food environment. Given the poor nutritional quality of purchases, findings support the need for interventions that address customer decision making in these stores.

Incentivizing fruit and vegetable purchases among participants in the Special Supplemental Nutrition Program for Women, Infants, and Children.

PubMed

Andreyeva, Tatiana; Luedicke, Joerg

2015-01-01

In 2009, the US Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) began to provide participants with cash-value vouchers to purchase fruits and vegetables ($US 10 for women and $US 6 for children per month). The present paper assesses the potential effects of the new WIC incentives on fruit and vegetable purchases among WIC households in two New England states. A pre-post assessment of changes in fruit and vegetable purchases after the WIC revisions in generalized estimating equation models. Scanner data on grocery purchases from a regional supermarket chain in New England, USA. WIC-participating households (n 2137) that regularly shopped at the chain during January-September 2009 and January-September 2010. After the WIC revisions, purchases of fresh and frozen vegetables increased in volume by 17·5 % and 27·8 %, respectively. The biggest improvements were observed for fresh fruit, an increase of 28·6 %, adding almost a kilogram of fresh fruits per household per month. WIC households spent three times more of their WIC vouchers on purchasing fresh fruits than fresh vegetables. The magnitudes of substitution effects were relatively small: between 4 % (fresh fruit) and 13 % (canned vegetables) of the amounts purchased in 2009 with non-WIC funds were replaced by purchases made using WIC vouchers in 2010. The provision of fruit and vegetable benefits in the revised WIC food packages increased overall purchases of fruits and vegetables among WIC-participating households in New England. Efforts to encourage consumption of fruits and vegetables by people receiving federal food assistance are paying off.

78 FR 78424 - Order Granting a Limited Exemption From Rule 102(a) of Regulation M to Certain Business...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-26

..., purchasing, or attempting to induce another person to bid for or purchase a ``covered security'' until the... purchases of Shares or any reference security by the Company or any affiliated purchaser of the Company are... trusts to permit similar repurchase programs.\\4\\ Based on our experience with these prior requests, we...

Place over traits? Purchasing edibles from medical marijuana dispensaries in Los Angeles, CA.

PubMed

Kepple, Nancy Jo; Freisthler, Bridget

2017-10-01

To examine discrete purchasing behaviors of marijuana-infused edibles from medical marijuana dispensaries with the aim to identify potential venue- and individual-level targets for prevention. Two-stage, venue-based sampling approach was used to randomly select patrons exiting 16 medical marijuana dispensaries in Los Angeles, California during Spring 2013. Hierarchical generalized linear modeling was used to examine the likelihood of purchasing edibles among 524 patrons reporting a discrete purchase regressed on characteristics of the sampled dispensaries and their patrons. At a venue level, patrons were more likely to purchase edibles from dispensaries located within Census tracts with higher median incomes or in close proximity to a higher number of dispensaries. At an individual level, patrons who identified as Black or Hispanic were associated with a lower likelihood of purchasing edibles when compared to patrons who identified as other non-White, non-Hispanic race/ethnicity. Place-based policies focused on regulating edible sales through dispensaries may be fruitful in influencing access to edibles. Additionally, social marketing campaigns may benefit from targeting both locations where edible purchases are more likely and populations who are more likely to purchase edibles. Copyright © 2017 Elsevier Ltd. All rights reserved.

Purchasing oncology services. Kerr L. White Institute/American Cancer Society Task Force on Purchasing Oncology Services.

PubMed

Cangialose, C B; Blair, A E; Borchardt, J S; Ades, T B; Bennett, C L; Dickersin, K; Gesme, D H; Henderson, I C; McGinnis, L S; Mooney, K; Mortenson, L E; Sperduto, P; Winkenwerder, W; Ballard, D J

2000-06-15

A multidisciplinary panel representing various stakeholders in the health care delivery and oncology services marketplace was convened to develop specific criteria for healthcare purchasers to consider when evaluating the structures and processes of health plans. These rank ordered criteria also can be used by oncologic service providers and health plan designers as a yardstick for the services they offer. A multidisciplinary 31-member Task Force was assembled by the Kerr L. White Institute and the American Cancer Society in March 1997. Task Force members were selected for their ability to offer expert insight as purchasers, suppliers, policymakers, consumers, or stakeholders in the health care marketplace. A preference-weighted majority voting rule was used to identify the three most important recommendations of the 10 that were generated through a modified Delphi technique. To test the practicality of the top three recommendations, leaders of large managed care organizations (MCOs) were surveyed; the results of this survey then were compared with the results of the Task Force survey. The three most important recommendations from the Task Force were that health plans provide access to: 1) comprehensive cancer care, 2) preventive and screening services, and 3) second opinions and treatment options supported by scientific evidence. The difference between the responses of the Task Force and the MCOs was that MCOs placed the highest importance on evidence-based decision-making, with their next three rankings coinciding with those identified by the Task Force. The value of these summary recommendations will be realized through their use by both purchasers and suppliers to influence the structure and content of the delivery of oncologic services.

Socioeconomic inequalities in expenditures and income committed to the purchase of medicines in Southern Brazil.

PubMed

Boing, Alexandra Crispim; Bertoldi, Andréa Dâmaso; Peres, Karen Glazer

2011-10-01

To describe socioeconomic inequalities regarding the use, expenditures and the income committed to the purchase of medicines. A cross-sectional population-based study was carried out with 1,720 adults living in the urban area of Florianópolis, Southern Brazil, in 2009. Cluster sampling was adopted and census tracts were the primary sampling units. Use of medicines and the expenditures incurred in their purchase in the past 30 days were investigated through interviews. Use, expenditures and the income committed concerning medicines were analyzed according to per capita family income, self-reported skin color, age and sex, adjusting for the complex sample. The prevalence of medicine use was 76.5% (95%CI: 73.8; 79.3), higher among women and in older individuals. The mean expenditure on medicine was R$ 46.70, with higher values among women, whites, older individuals and among richer people. While 3.1% of the richest committed more than 15% of their income to purchasing medicine, that figure reached 9.6% in the poorest group. The proportion of people that had to buy medicines after an unsuccessful attempt to obtain them in the public health system was higher among the poor (11.0%), women (10.2%) and the elderly (11.1%). A large part of the adults bought medicines contained in the National List of Essential Medicines (19.9%) or in the Municipal List of Essential Medicines (28.6%), with significant differences according to gender, age and income. There is socioeconomic, age and gender inequality in the income committed to the purchase of medicines, with worse conditions for the poor, older individuals and women.

Calories from beverages purchased at 2 major coffee chains in New York City, 2007.

PubMed

Huang, Christina; Dumanovsky, Tamara; Silver, Lynn D; Nonas, Cathy; Bassett, Mary T

2009-10-01

Calorie intake from beverages has increased in the past decades, which most likely contributes to higher obesity rates. Although coffee chains have grown in popularity in recent years, few data examine the calorie contribution of these drinks. We examined afternoon beverage purchases in New York City at 2 major coffee chains and estimated the mean calorie content of these beverages. We collected purchase receipts and brief surveys from adult customers at 42 Starbucks and 73 Dunkin' Donuts stores during the spring of 2007. For each purchase, we obtained the calorie content from the company's Web site; these values were adjusted to account for self-reported customization of the drink. We included 1,127 beverage purchases at Starbucks and 1,830 at Dunkin' Donuts in our analyses. Brewed coffee or tea averaged 63 kcal, and blended coffee beverages averaged 239 kcal. Approximately two-thirds of purchases at Starbucks and one-fourth of purchases at Dunkin' Donuts were blended coffee beverages. Calories in blended coffee beverages are high; on average, customers bought 12% of a 2,000-kcal diet. Policy changes to provide for calorie posting at the point of purchase could increase customer awareness of the calories in these beverages; modifying standard formulations of blended coffee beverages, such as using low-fat milk or smaller serving sizes, would also reduce calorie content.

A conceptual schema for government purchasing arrangements for Australian alcohol and other drug treatment.

PubMed

Ritter, Alison; Hull, Philip; Berends, Lynda; Chalmers, Jenny; Lancaster, Kari

2016-09-01

The aim of this study was to establish a conceptual schema for government purchasing of alcohol and other drug treatment in Australia which could encompass the diversity and variety in purchasing arrangements, and facilitate better decision-maker by purchasers. There is a limited evidence base on purchasing arrangements in alcohol and drug treatment despite the clear impact of purchasing arrangements on both treatment processes and treatment outcomes. The relevant health and social welfare literature on purchasing arrangements was reviewed; data were collected from Australian purchasers and providers of treatment giving detailed descriptions of the array of purchasing arrangements. Combined analysis of the literature and the Australian purchasing data resulted in a draft schema which was then reviewed by an expert committee and subsequently finalised. The conceptual schema presented here was purpose-built for alcohol and other drug treatment, with its overlap between health and social welfare services. It has three dimensions: 1. The ways in which providers are chosen; 2. The ways in which services are paid for; and 3. How price is managed. Distinguishing between the methods for choosing providers (such as competitive or individually negotiated processes) from the way in which organisations are paid for their provision of treatment (such as via a block grant or payment for activity) provides conceptual clarity and enables closer analysis of each mechanism. Governments can improve health and wellbeing by making informed decisions about the way they purchase and fund alcohol and other drug treatment. Research comparing different purchasing arrangements can provide a vital evidence-base to inform funders; however a first step is to accurately and consistently categorise current approaches against a typology or conceptual schema. Copyright © 2016 Elsevier Ltd. All rights reserved.

Reductions in High-End Imaging Utilization With Radiology Review and Consultation.

PubMed

Ingraham, Bailey; Miller, Kristen; Iaia, Alberto; Sneider, Michael B; Naqvi, Shabbir; Evans, Kimberly; Gheyi, Vinay; Anzilotti, Kert

2016-09-01

Following the uptake of value-based purchasing in concert with health care reform in the United States, providers, insurers, and patients are looking for ways to reduce excessive, dangerous, and/or inappropriate high-end imaging utilization (HEIU). Inappropriate HEIU is associated with patient safety risks due to unnecessary exposure to radiation, misappropriation of scarce equipment resources and staff, complications to clinical care, and needless, excessive costs for the patient, hospital, and payer. This paper presents a cost-effective radiology-initiated improvement program piloted in the Christiana Hospital Coordinated Care Network. The pilot demonstrated the effectiveness of regulating high-end imaging orders through radiologists' review of requests of the order as part of the consult process. Over the 2014-2015 fiscal year, 2,177 high-end imaging orders were reviewed by 26 radiologists for approval, rejection, or recommendation of an alternate examination. Of the orders, 86.7% (1887) were approved, 4.0% (87) were rejected, and 9.3% (203) received recommendation for an alternate examination. Based on improved patient safety, cost savings, and appropriate resource use, these findings suggest that radiologists' review can effectively reduce excessive HEIU. This method, with an appropriate algorithm to assist with handling a larger volume of orders, would be ideal to implement systemwide to manage HEIU cost efficiency, simultaneously providing radiologists with more control in their area of expertise and positively impacting quality, safety, and value-based purchasing goals. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Do employers know the quality of health care benefits they provide? Use of HEDIS depression scores for health plans.

PubMed

Robst, John; Rost, Kathryn; Marshall, Donna

2013-11-01

OBJECTIVE Dissemination of health quality measures is a necessary ingredient of efforts to harness market-based forces, such as value-based purchasing by employers, to improve health care quality. This study examined reporting of Healthcare Effectiveness Data and Information Set (HEDIS) measures for depression to firms interested in improving depression care. METHODS During surveys conducted between 2009 and 2011, a sample of 325 employers that were interested in improving depression treatment were asked whether their primary health plan reports HEDIS scores for depression to the National Committee for Quality Assurance (NCQA) and if so, whether they knew the scores. Data about HEDIS reporting by the health plans were collected from the NCQA. RESULTS HEDIS depression scores were reported by the primary health plans of 154 (47%) employers, but only 7% of employers knew their plan's HEDIS scores. Because larger employers were more likely to report knowing the scores, 53% of all employees worked for employers who reported knowing the scores. A number of structural, health benefit, and need characteristics predicted knowledge of HEDIS depression scores by employers. CONCLUSIONS The study demonstrated that motivated employers did not know their depression HEDIS scores even when their plan publicly reported them. Measures of health care quality are not reaching the buyers of insurance products; however, larger employers were more likely to know the HEDIS scores for their health plan, suggesting that value-based purchasing may have some ability to affect health care quality.

After Mexico Implemented a Tax, Purchases of Sugar-Sweetened Beverages Decreased and Water Increased: Difference by Place of Residence, Household Composition, and Income Level.

PubMed

Colchero, M Arantxa; Molina, Mariana; Guerrero-López, Carlos M

2017-08-01

Background: In January 2014, Mexico implemented a tax on sugar-sweetened beverage (SSB) purchases of 1 peso/L. Objective: We examined the heterogeneity of changes in nonalcoholic beverage (SSB and bottled water) purchases after the tax was implemented by household income, urban and rural strata, and household composition. Methods: We used 4 rounds of the National Income and Expenditure Surveys: 2008, 2010, 2012, and 2014. Changes in purchases in per capita liters per week were estimated with the use of 2-part models to adjust for nonpurchases. We compared absolute and relative differences between adjusted changes in observed purchases in 2014 with expected purchases in 2014 based on prior trends (2008-2012). The models were adjusted for sociodemographic characteristics of the households, place of residence, and lagged gross domestic product per capita. Results: We found a 6.3% reduction in the observed purchases of SSBs in 2014 compared with the expected purchases in that same year based on trends from 2008 to 2012. These reductions were higher among lower-income households, residents living in urban areas, and households with children. We also found a 16.2% increase in water purchases that was higher in low- and middle-income households, in urban areas, and among households with adults only. Conclusions: SSB purchases decreased and water purchases increased after an SSB tax was imposed in Mexico. The magnitude of these changes was greater in lower-income and urban households. © 2017 American Society for Nutrition.

Pay for performance: will dentistry follow?

PubMed

Voinea-Griffin, Andreea; Fellows, Jeffrey L; Rindal, Donald B; Barasch, Andrei; Gilbert, Gregg H; Safford, Monika M

2010-04-28

"Pay for performance" is an incentive system that has been gaining acceptance in medicine and is currently being considered for implementation in dentistry. However, it remains unclear whether pay for performance can effect significant and lasting changes in provider behavior and quality of care. Provider acceptance will likely increase if pay for performance programs reward true quality. Therefore, we adopted a quality-oriented approach in reviewing those factors which could influence whether it will be embraced by the dental profession. The factors contributing to the adoption of value-based purchasing were categorized according to the Donabedian quality of care framework. We identified the dental insurance market, the dental profession position, the organization of dental practice, and the dental patient involvement as structural factors influencing the way dental care is practiced and paid for. After considering variations in dental care and the early stage of development for evidence-based dentistry, the scarcity of outcome indicators, lack of clinical markers, inconsistent use of diagnostic codes and scarcity of electronic dental records, we concluded that, for pay for performance programs to be successfully implemented in dentistry, the dental profession and health services researchers should: 1) expand the knowledge base; 2) increase considerably evidence-based clinical guidelines; and 3) create evidence-based performance measures tied to existing clinical practice guidelines. In this paper, we explored factors that would influence the adoption of value-based purchasing programs in dentistry. Although none of these factors were essential deterrents for the implementation of pay for performance programs in medicine, the aggregate seems to indicate that significant changes are needed before this type of program could be considered a realistic option in dentistry.

Art at the Mall: A Look at the Aesthetics of Popular Mall Art Culture

ERIC Educational Resources Information Center

Szekely, Ilona

2008-01-01

Currently there is a scarcity of information in the art education literature about purchasing art. This article examines how art acquires economic and social value, as well as how consumers make decisions when purchasing a piece of art. Where does an art student, or the general public learn about buying art? How much, if any, of this process is…

Design and implementation of ticket price forecasting system

NASA Astrophysics Data System (ADS)

Li, Yuling; Li, Zhichao

2018-05-01

With the advent of the aviation travel industry, a large number of data mining technologies have been developed to increase profits for airlines in the past two decades. The implementation of the digital optimization strategy leads to price discrimination, for example, similar seats on the same flight are purchased at different prices, depending on the time of purchase, the supplier, and so on. Price fluctuations make the prediction of ticket prices have application value. In this paper, a combination of ARMA algorithm and random forest algorithm is proposed to predict the price of air ticket. The experimental results show that the model is more reliable by comparing the forecasting results with the actual results of each price model. The model is helpful for passengers to buy tickets and to save money. Based on the proposed model, using Python language and SQL Server database, we design and implement the ticket price forecasting system.

Gregg O. Lehman on healthcare business coalitions, purchasing, and health policy. Interview by Joann Genovich-Richards.

PubMed

Lehman, G O

2000-01-01

As President and CEO of the National Business Coalition on Health (NBCH), Gregg Lehman leads a movement of 90 business coalitions nationwide seeking cost-effective, better quality healthcare for employees and their families. Member coalitions represent more than 8,000 employers with more than 32 million employees and dependents. Dr. Lehman has 25 years of leadership experience in higher education, private business, and a national association. In his current position, Dr. Lehman is actively working with coalitions to promote their role in relation to value-based healthcare purchasing and health policy issues. In addition, he is actively developing NBCH into an enterprise that assists local coalitions in developing national contracts and strategic partnerships for healthcare products and services. Dr. Lehman earned a PhD in higher education administration, with a minor in finance and economics, from Purdue University.

Selling Your Child Care Business: Determining Its Value.

ERIC Educational Resources Information Center

Neugebauer, Roger

1997-01-01

Reviews steps to determine the sale value of a privately owned child care business, including determining current pre-tax earnings, calculating add-backs, applying discounts, determining discretionary earnings, determining the appropriate multiple, and computing the center's value. Presents common structures of center purchases and negotiating…

Barriers to Pharmacy-Based Syringe Purchase Among Injection Drug Users in Tijuana, Mexico: A Mixed Methods Study

PubMed Central

Lozada, Remedios; Gallardo, Manuel; Rosen, Perth; Vera, Alicia; Macias, Armando; Palinkas, Lawrence A.; Strathdee, Steffanie A.

2010-01-01

Injection drug users (IDUs) may be denied purchase of sterile syringes even where purchase without a prescription is legal. This study examined barriers to over-the-counter (OTC) syringe purchase among IDUs in Tijuana, Mexico. A quantitative survey and subsequent focus groups were used to quantify barriers to purchase, identify their correlates and provide in-depth exploration of syringe purchase experiences. Of 627 IDUs, 81% purchased a syringe in the past 6 months and 16% were refused or overcharged. Factors independently associated with refusal/overcharging were homelessness, receptive syringe sharing, >5 uses per syringe, and number of lifetime abscesses. Few pharmacies sold syringes to IDUs, who adapted by limiting purchase attempts to pharmacies known to sell syringes consistently. Failed purchases occurred when drug withdrawal required purchase at unusual times or locations, often following release from jail. IDUs reported syringe sharing, syringe reuse, and searching through unsecured medical waste for syringes in response to failed purchase attempts. Interventions to expand OTC syringe sales to IDUs, particularly near detention facilities, will facilitate safer injection practices. PMID:20300820

Influences of packaging attributes on consumer purchase decisions for fresh produce.

PubMed

Koutsimanis, Georgios; Getter, Kristin; Behe, Bridget; Harte, Janice; Almenar, Eva

2012-10-01

Packaging attributes are considered to have an influence on consumer purchase decisions for food and, as a consequence, also on its consumption. To improve the current minimal understanding of these influences for fresh produce, a survey instrument in the form of an online questionnaire has been developed and launched in the US. The first part of the questionnaire covers consumers' preferences for packaging convenience features, characteristics, materials, disposal method, and others for fresh produces in general, and the second focuses on attributes like price, container size, produce shelf life for a specific fresh produce, sweet cherries, to allow us to supply specific values for these factors to the participants. Cluster and conjoint analyses of responses from 292 participants reveal that specific packaging and produce attributes affect consumer purchase decisions of fresh produce in general and of sweet cherries in particular (P ≤ 0.05) and that some are population segment dependent (P ≤ 0.05). For produce packaging in general, 'extend the "best by" date' was ranked as the top convenience feature, the type of packaging material was considered to affect the food product quality (92.7%) and containers made from bio-based materials were highly appealing (3.52 out of 5.00). The most important attributes that affect the purchasing decisions of consumers regarding a specific fresh produce like sweet cherries are price (25%), shelf life (19%) and container size (17.2%). Copyright © 2012 Elsevier Ltd. All rights reserved.

Quantifying the Army Supply Chain Water Bootprint

DTIC Science & Technology

2011-12-01

Guns, through 30mm Other FSCs 4-3 Several factors affect the accuracy of this result :  A major drawback of the Eco- LCA model is that each economic...inflated values produced by the Eco- LCA model. In spite of these issues, the resulting Army water bootprint estimate, although coarse, does provide a...for bulk fuel purchases, the Eco- LCA approach results in a water footprint eight times larger than a footprint that uses literature- based water

The Theory of Value-Based Payment Incentives and Their Application to Health Care.

PubMed

Conrad, Douglas A

2015-12-01

To present the implications of agency theory in microeconomics, augmented by behavioral economics, for different methods of value-based payment in health care; and to derive a set of future research questions and policy recommendations based on that conceptual analysis. Original literature of agency theory, and secondarily behavioral economics, combined with applied research and empirical evidence on the application of those principles to value-based payment. Conceptual analysis and targeted review of theoretical research and empirical literature relevant to value-based payment in health care. Agency theory and secondarily behavioral economics have powerful implications for design of value-based payment in health care. To achieve improved value-better patient experience, clinical quality, health outcomes, and lower costs of care-high-powered incentives should directly target improved care processes, enhanced patient experience, and create achievable benchmarks for improved outcomes. Differing forms of value-based payment (e.g., shared savings and risk, reference pricing, capitation, and bundled payment), coupled with adjunct incentives for quality and efficiency, can be tailored to different market conditions and organizational settings. Payment contracts that are "incentive compatible"-which directly encourage better care and reduced cost, mitigate gaming, and selectively induce clinically efficient providers to participate-will focus differentially on evidence-based care processes, will right-size and structure incentives to avoid crowd-out of providers' intrinsic motivation, and will align patient incentives with value. Future research should address the details of putting these and related principles into practice; further, by deploying these insights in payment design, policy makers will improve health care value for patients and purchasers. © Health Research and Educational Trust.

Reducing uninsurance through the nongroup market: health insurance credits and purchasing groups.

PubMed

McClellan, Mark; Baicker, Katherine

2002-01-01

The president's proposal to introduce tax credits for the purchase of health insurance will enable millions of Americans to purchase private health insurance, improving the functioning of private markets, empowering patients to make informed decisions, and increasing the use of high-value health care. Evidence points to the availability of comprehensive individual insurance for the young and the old, the sick and the healthy. There are a number of policies that would increase access to the nongroup market, none of which would adversely affect group markets. These policies together will ensure that all Americans have good, affordable health insurance choices available to them.

Design the price signal mechanism of suppliers' cost in the commercial procurement process

NASA Astrophysics Data System (ADS)

Jinming, Huang; Wenjing, Li; Huazhen, Zhu

2016-06-01

In the process of commercial procurement, there exists information asymmetry between purchasers and suppliers in terms of commodity cost. The strike price is what purchasers care about, while the focus of suppliers is only the sales revenue. In order to achieve the relatively lower strike price, purchasers need to design a price signal mechanism, explicating the commodity cost of suppliers. In this article, we have designed a mechanism that purchasers can explicit the commodity cost price based on suppliers' choices by providing a variety of purchase contracts to suppliers.

[Consumer's psychological processes of hoarding and avoidant purchasing after the Tohoku earthquake].

PubMed

Ohtomo, Shoji; Hirose, Yukio

2014-02-01

This study examined psychological processes of consumers that had determined hoarding and avoidant purchasing behaviors after the Tohoku earthquake within a dual-process model. The model hypothesized that both intentional motivation based on reflective decision and reactive motivation based on non-reflective decision predicted the behaviors. This study assumed that attitude, subjective norm and descriptive norm in relation to hoarding and avoidant purchasing were determinants of motivations. Residents in the Tokyo metropolitan area (n = 667) completed internet longitudinal surveys at three times (April, June, and November, 2011). The results indicated that intentional and reactive motivation determined avoidant purchasing behaviors in June; only intentional motivation determined the behaviors in November. Attitude was a main determinant of the motivations each time. Moreover, previous behaviors predicted future behaviors. In conclusion, purchasing behaviors were intentional rather than reactive behaviors. Furthermore, attitude and previous behaviors were important determinants in the dual-process model. Attitude and behaviors formed in April continued to strengthen the subsequent decisions of purchasing behavior.

National valuation of monarch butterflies indicates an untapped potential for incentive-based conservation

USGS Publications Warehouse

Diffendorfer, Jay E.; Loomis, John B.; Ries, Leslie; Oberhauser, Karen; Semmens, Darius; Semmens, Brice; Butterfield, Bruce; Bagstad, Ken; Goldstein, Josh; Wiederholt, Ruscena; Mattsson, Brady; Thogmartin, Wayne E.

2013-01-01

The annual migration of monarch butterflies (Danaus plexippus) has high cultural value and recent surveys indicate monarch populations are declining. Protecting migratory species is complex because they cross international borders and depend on multiple regions. Understanding how much, and where, humans place value on migratory species can facilitate market-based conservation approaches. We performed a contingent valuation study of monarchs to understand the potential for such approaches to fund monarch conservation. The survey asked U.S. respondents about the money they would spend, or have spent, growing monarch-friendly plants, and the amount they would donate to monarch conservation organizations. Combining planting payments and donations, the survey indicated U.S. households valued monarchs as a total one-time payment of $4.78–$6.64 billion, levels similar to many endangered vertebrate species. The financial contribution of even a small percentage of households through purchases or donations could generate new funding for monarch conservation through market-based approaches.

Analysis of consumer behavior in decision making of purchasing ornamental freshwater fish (case of study at ornamental freshwater fish market at Peta Street, Bandung)

NASA Astrophysics Data System (ADS)

Gumilar, I.; Rizal, A.; Sriati; Setiawan Putra, R.

2018-04-01

This research aim was to analyzed process of decision making of purchasing ornamental freshwater fish at Peta Street, Bandung City and Analyzed what factors are driving consumers to buy freshwater fish Peta Street. The method used in this research is case study with rating scale and rank spearman analysis. The sampling technique is the accidental random sampling method consist of 30 respondents. The consumer’s decision making process consist of five stages, namely the recognition of needs, information searching, alternative evaluation, process of purchasing, and the evaluation of results. The results showed that at the stage of recognition of needs the motivation of purchasing freshwater fish because respondents are very fond of ornamental freshwater fish, at the stage of information search, the information sources are from the print media and friends or neighborhood. At the stage of alternative evaluation, the reason consumers buy ornamental freshwater fish because the quality of good products. The stage of purchasing decision process consumers bought 1-5 fish with frequency of purchase 1 time per month. The evaluation of results of post-purchasing consumers feel very satisfied with the fish products and the price is very affordable. To observe the factors that influence purchasing motivation of consumers, spearman rank test is the method. The results showed that the quality and price of the product are the factors that most influence the purchase decision of ornamental freshwater fish with the range of student-t value 3,968 and 2,107.

7 CFR 1485.23 - Miscellaneous provisions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... refunds generated from an activity, i.e., participation fees, proceeds of sales, refunds of value added... shall maintain an inventory of all capital goods with a value of $100 acquired in furtherance of program..., cost of purchase, replacement value, serial number, make, model, and electrical requirements. (3) The...

Expected value analysis for integrated supplier selection and inventory control of multi-product inventory system with fuzzy cost

NASA Astrophysics Data System (ADS)

Sutrisno, Widowati, Tjahjana, R. Heru

2017-12-01

The future cost in many industrial problem is obviously uncertain. Then a mathematical analysis for a problem with uncertain cost is needed. In this article, we deals with the fuzzy expected value analysis to solve an integrated supplier selection and supplier selection problem with uncertain cost where the costs uncertainty is approached by a fuzzy variable. We formulate the mathematical model of the problems fuzzy expected value based quadratic optimization with total cost objective function and solve it by using expected value based fuzzy programming. From the numerical examples result performed by the authors, the supplier selection problem was solved i.e. the optimal supplier was selected for each time period where the optimal product volume of all product that should be purchased from each supplier for each time period was determined and the product stock level was controlled as decided by the authors i.e. it was followed the given reference level.

Factors Influencing the Food Purchases of Early Care and Education Providers.

PubMed

Otten, Jennifer J; Hirsch, Tad; Lim, Catherine

2017-05-01

With the majority of US children enrolled in some form of early care and education, the settings for early care and education represent a valuable opportunity to positively impact young children's diets and their interactions with food. Little evidence exists on how early care and education providers make food purchasing and service decisions for this population of young children. Our aim was to explore the factors that influence early care and education providers' food purchasing and service decisions. A qualitative design consisting of individual, in-person, and semi-structured interviews with providers and on-site observations was used. Sixteen early care and education providers-selected across a variety of characteristics that might affect food selection (eg, size of site, participation in reimbursement programs, presence of staff assigned to foodservice) using maximum variation purposive sampling-based in the Puget Sound region, Washington, were interviewed from June to September 2014. Provider perspectives on food purchasing and service decisions. Inductive analysis of transcribed interviews using TAMS Analyzer software (GPL version 2, 2012) to identify themes. Ten main influencers emerged from the data. These were grouped into four categories based on an ecological framework: macro-level environments (ie, regulations; suppliers and vendors, including stores); physical environment and settings (ie, organizational mission, budget, and structure; the facility itself); social environments (ie, professional networks; peers; the site-specific parent and child community); and individual factors at both a provider and child-level (ie, providers' skills, behaviors, motivations, attitudes, knowledge, and values; child food preferences; and, child allergies). A model was then developed to identify potential pathways of intervention and underscore the need for a comprehensive approach to improve early care and education nutrition. This study suggests that a more system-based understanding and approach-one that accounts for an array of influencers and their interactions-is necessary to take advantage of opportunities and address barriers to improving early care and education-based nutrition. Copyright © 2017 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

The impact of financial incentives on participants' food purchasing patterns in a supermarket-based randomized controlled trial.

PubMed

Olstad, Dana Lee; Crawford, David A; Abbott, Gavin; McNaughton, Sarah A; Le, Ha Nd; Ni Mhurchu, Cliona; Pollard, Christina; Ball, Kylie

2017-08-25

The impacts of supermarket-based nutrition promotion interventions might be overestimated if participants shift their proportionate food purchasing away from their usual stores. This study quantified whether participants who received price discounts on fruits and vegetables (FV) in the Supermarket Healthy Eating for Life (SHELf) randomized controlled trial (RCT) shifted their FV purchasing into study supermarkets during the intervention period. Participants were 642 females randomly assigned to a 1) skill-building (n = 160), 2) price reduction (n = 161), 3) combined skill-building and price reduction (n = 160), or 4) control (n = 161) group. Participants self-reported the proportion of FV purchased in study supermarkets at baseline, 3- and 6-months post-intervention. Fisher's exact and χ 2 tests assessed differences among groups in the proportion of FV purchased in study supermarkets at each time point. Multinomial logistic regression assessed differences among groups in the change in proportionate FV purchasing over time. Post-intervention, 49% of participants purchased ≥50% of their FV in study supermarkets. Compared to all other groups, the price reduction group was approximately twice as likely (RRR: 1.8-2.2) to have increased proportionate purchasing of FV in study supermarkets from baseline to post-intervention (p< 0.05). Participants who received price reductions on FV were approximately twice as likely to shift their FV purchasing from other stores into study supermarkets during the intervention period. Unless food purchasing data are available for all sources, differential changes in purchasing patterns can make it difficult to discern the true impacts of nutrition interventions. The SHELf trial is registered with Current Controlled Trials Registration ISRCTN39432901, Registered 30 June 2010, Retrospectively registered ( http://www.isrctn.com/ISRCTN39432901 ).

Buyer's Guide to Classroom Furniture.

ERIC Educational Resources Information Center

Neugebauer, Roger

1996-01-01

Provides advice to child care center directors on purchasing the center's furniture. Contains a series of questions that directors should ask related to purchasing furniture, based on advice from manufacturers and dealers. Summarizes the key factors needed to consider when purchasing classroom furniture and includes tips on buying from catalogs…

49 CFR 639.23 - Calculation of purchase or construction cost.

Code of Federal Regulations, 2014 CFR

2014-10-01

...) Ancillary costs such as delivery and installation; plus (3) The net present value of the estimated future... the fair market value of the asset as of the date the lease will terminate pursuant to Guidelines...

49 CFR 639.23 - Calculation of purchase or construction cost.

Code of Federal Regulations, 2012 CFR

2012-10-01

...) Ancillary costs such as delivery and installation; plus (3) The net present value of the estimated future... the fair market value of the asset as of the date the lease will terminate pursuant to Guidelines...

49 CFR 639.23 - Calculation of purchase or construction cost.

Code of Federal Regulations, 2013 CFR

2013-10-01

...) Ancillary costs such as delivery and installation; plus (3) The net present value of the estimated future... the fair market value of the asset as of the date the lease will terminate pursuant to Guidelines...

49 CFR 639.23 - Calculation of purchase or construction cost.

Code of Federal Regulations, 2011 CFR

2011-10-01

...) Ancillary costs such as delivery and installation; plus (3) The net present value of the estimated future... the fair market value of the asset as of the date the lease will terminate pursuant to Guidelines...

Generalized Method for the User Evaluation of Purchased Information Services. Report Number Three; Monthly Report (October 1 to November 30, 1975).

ERIC Educational Resources Information Center

Hall, Homer J.

Four case histories were studied in an on-going project to develop a method for user selection of purchased scientific and technical information services. The issues involved were: (1) the value of computer search services to a small branch of a company technical library; (2) the special decision-making factors used for selecting items of very…

The Potential for Conflict in Latin America: A Cross-National Study.

DTIC Science & Technology

1980-05-16

production are not lost on any Chilean. The Argentine arms industry , the recent purchase of modern, highly lethal military equipment, and the nuclear...national strength or vulnerability is the value of government revenues as a percentage of gross domestic product . This indicator measures the degree to... industry . $3 billion in virtually any context is a significant amount of weaponry. The implications of these purchases along with Argentine arms

An Empirical Examination of Counterdrug Interdiction Program Effectiveness.

DTIC Science & Technology

1997-01-01

inversely correlated with the street price index. Chapter IV examines the time dependence of the street price index and argues that interdiction activities...essentially asymptotic behavior in which the cumulative distribution function, for large values of the independent variable, converges to an inverse power-law...log(S) /log(M). Such an inverse power-law relation between unit purchase price and purchase volume is indeed observed within the STRIDE data

Role of expendable income and price in food choice by low income families.

PubMed

Burns, Cate; Cook, Kay; Mavoa, Helen

2013-12-01

The public health literature suggests that the cheapness of energy-dense foods is driving the obesity epidemic. We examined food purchases in low-income families and its relationship to the price of food and availability of funds. In-depth interviews were conducted with 22 parents with children less than 15 years of age whose major source of income was a government pension. A photo taxonomy, where participants sorted 50 photos of commonly purchased foods, was used to explore food choice. The most common food groupings used by the participants were: basic, emergency, treat and comfort. The process of food purchase was described by participants as weighing up the attributes of a food in relation to price and money available. Shoppers nominated the basic unit of measurement as quantity per unit price and the heuristic for food choice when shopping as determining "value for money" in a process of triage relating to food purchase decisions. Participants stated satiation of hunger to be the most common "value" relative to price. Given that the foods nominated as filling tended to be carbohydrate-rich staples, we suggest that public health initiatives need to acknowledge this triage process and shape interventions to promote nutrition over satiation. Copyright © 2013 Elsevier Ltd. All rights reserved.

Emerging Lessons From Regional and State Innovation in Value-Based Payment Reform: Balancing Collaboration and Disruptive Innovation

PubMed Central

Conrad, Douglas A; Grembowski, David; Hernandez, Susan E; Lau, Bernard; Marcus-Smith, Miriam

2014-01-01

Policy Points: Public and private purchasersmust create a "burning bridge" of countervailing pressure that signals "no turning back" to fee-for-service in order to sustain the momentum for value-based payment. Multi-stakeholder coalitions must establish a defined set of quality, outcomes, and cost performance measures and the interoperable information systems to support data collection and reporting of value-based payment schemes. Anti-trust vigilance is necessary to find the "sweet spot" of competition and cooperation among health plans and health care providers. Provider and health plan transparency of price and quality, supported by all-payer claims data, are critical in driving value-based payment innovation and cost constraint. Context In recent decades, practitioners and policymakers have turned to value-based payment initiatives to help contain spending on health care and to improve the quality of care. The Robert Wood Johnson Foundation funded 7 grantees across the country to design and implement value-based, multistakeholder payment reform projects in 6 states and 3 regions of the United States. Methods As the external evaluator of these projects, we reviewed documents, conducted Internet searches, interviewed key stakeholders, cross-validated factual and narrative interpretation, and performed qualitative analyses to derive cross-site themes and implications for policy and practice. Findings The nature of payment reform and its momentum closely reflects the environmental context of each project. Federal legislation such as the Patient Protection and Affordable Care Act and federal and state support for the development of the patient-centered medical home and accountable care organizations encourage value-based payment innovation, as do local market conditions for payers and providers that combine a history of collaboration with independent innovation and experimentation by individual organizations. Multistakeholder coalitions offer a useful facilitating structure for galvanizing payment reform. But to achieve the objectives of reduced cost and improved quality, multistakeholder payment innovation must overcome such barriers as incompatible information systems, the technical difficulties and transaction costs of altering existing billing and payment systems, competing stakeholder priorities, insufficient scale to bear population health risk, providers’ limited experience with risk-bearing payment models, and the failure to align care delivery models with the form of payment. Conclusions From the evidence adduced in this article, multistakeholder, value-based payment reform requires a trusted, widely respected “honest broker” that can convene and maintain the ongoing commitment of health plans, providers, and purchasers. Change management is complex and challenging, and coalition governance requires flexibility and stable leadership, as market conditions and stakeholder engagement and priorities shift over time. Another significant facilitator of value-based payment reform is outside investment that enables increased investment in human resources, information infrastructure, and care management by provider organizations and their collaborators. Supportive community and social service networks that enhance population health management also are important enablers of value-based payment reform. External pressure from public and private payers is fueling a “burning bridge” between the past of fee-for-service payment models and the future of payments based on value. Robust competition in local health plan and provider markets, coupled with an appropriate mix of multistakeholder governance, pressure from organized purchasers, and regulatory oversight, has the potential to spur value-based payment innovation that combines elements of “reformed” fee-for-service with bundled payments and global payments. PMID:25199900

Computer-Based Instruction for Purchasing Skills

ERIC Educational Resources Information Center

Ayres, Kevin M.; Langone, John; Boon, Richard T.; Norman, Audrey

2006-01-01

The purpose of this study was to investigate use of computers and video technologies to teach students to correctly make purchases in a community grocery store using the dollar plus purchasing strategy. Four middle school students diagnosed with intellectual disabilities participated in this study. A multiple probe across participants research…

The Importance of Teaching Management's Role in Capital Equipment Purchases.

ERIC Educational Resources Information Center

Silbergleid, Michael Ian

This essay discusses broadcasting and telecommunication management curricula and makes an argument for including instruction in capital equipment purchases. The argument is based on recent changes in the role of the television station department managers who in economically competitive times are involved in decisions about equipment purchasing. In…

13 CFR 120.1705 - Pool formation requirements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... requirements. SBA may adjust the Pool characteristics periodically based on program experience and market... a Pool involving a Pool Loan it does not own, it must purchase the Loan Interest it proposes to pool... purchase the Loan Interest and take it into inventory or settle the purchase of the Loan Interest through...

20 CFR 362.12 - Computation of amount of reimbursement.

Code of Federal Regulations, 2010 CFR

2010-04-01

....12 Section 362.12 Employees' Benefits RAILROAD RETIREMENT BOARD INTERNAL ADMINISTRATION, POLICY AND... paid in cash for the property or, if not acquired by purchase or exchange, the value at the time of... its depreciated value immediately before it was damaged or lost, less any salvage value. If the cost...

38 CFR 8.33 - Cash value for term-capped policies.

Code of Federal Regulations, 2010 CFR

2010-07-01

... policyholder may receive the cash value in a lump sum or may use the cash value to purchase paid-up insurance... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Cash value for term... NATIONAL SERVICE LIFE INSURANCE Appeals § 8.33 Cash value for term-capped policies. (a) What is a term...

A Nickel Ain't Worth a Dime Anymore: The Illusion of Money and the Rapid Encoding of Its True Value

PubMed Central

2013-01-01

People often evaluate money based on its face value and overlook its real purchasing power, known as the money illusion. For example, the same 100 Chinese Yuan can buy many more goods in Tibet than in Beijing, but such difference in buying power is usually underestimated. Using event related potential combined with a gambling task, we sought to investigate the encoding of both the real value and the face value of money in the human brain. We found that the self-reported pleasantness of outcomes was modulated by both values. The feedback related negativity (FRN), which peaks around 250ms after feedback and is believed to be generated in the anterior cingulate cortex (ACC), was only modulated by the true value but not the face value of money. We conclude that the real value of money is rapidly encoded in the human brain even when participants exhibit the money illusion at the behavioral level. PMID:23383044

A nickel ain't worth a dime anymore: the illusion of money and the rapid encoding of its true value.

PubMed

Yu, Rongjun; Huang, Yi

2013-01-01

People often evaluate money based on its face value and overlook its real purchasing power, known as the money illusion. For example, the same 100 Chinese Yuan can buy many more goods in Tibet than in Beijing, but such difference in buying power is usually underestimated. Using event related potential combined with a gambling task, we sought to investigate the encoding of both the real value and the face value of money in the human brain. We found that the self-reported pleasantness of outcomes was modulated by both values. The feedback related negativity (FRN), which peaks around 250ms after feedback and is believed to be generated in the anterior cingulate cortex (ACC), was only modulated by the true value but not the face value of money. We conclude that the real value of money is rapidly encoded in the human brain even when participants exhibit the money illusion at the behavioral level.

Impact of Provider Incentives on Quality and Value of Health Care.

PubMed

Doran, Tim; Maurer, Kristin A; Ryan, Andrew M

2017-03-20

The use of financial incentives to improve quality in health care has become widespread. Yet evidence on the effectiveness of incentives suggests that they have generally had limited impact on the value of care and have not led to better patient outcomes. Lessons from social psychology and behavioral economics indicate that incentive programs in health care have not been effectively designed to achieve their intended impact. In the United States, Medicare's Hospital Readmission Reduction Program and Hospital Value-Based Purchasing Program, created under the Affordable Care Act (ACA), provide evidence on how variations in the design of incentive programs correspond with differences in effect. As financial incentives continue to be used as a tool to increase the value and quality of health care, improving the design of programs will be crucial to ensure their success.

Ethical issues in purchasing: a field study of Midwest hospitals.

PubMed

Tomaszewski, K; Motwani, J

1995-01-01

A large sum of money is spent annually by salespeople on gifts and favors for purchasing executives. The provision of gifts and favors to buyers remains a common practice despite the fact that it often leads to ethical conflicts for purchasing executives, sales managers, and salespeople. This paper investigates the perceptions of 51 purchasing executives of midwest hospitals regarding their behavior towards certain buying practices, the favors offered by vendors, favors actually accepted, as well as purchasers' discomfort and repayment levels regarding indebtedness. Based on the data analysis, this paper provides conclusions and directions for future research.

Portfolio Purchasing Decision for Mobile Power Equipment of B2C E-Commerce Export Retailer Based on CVaR

NASA Astrophysics Data System (ADS)

Yanchun, Wan; Qiucen, Chen

2017-11-01

Purchasing is an important part of export e-commerce of B2C, which plays an important role on risk and cost control in supply management. From the perspective of risk control, the paper construct a CVaR model for portfolio purchase. We select a heavy sales mobile power equipment from a typical B2C e-commerce export retailer as study sample. This study optimizes the purchasing strategy of this type of mobile power equipment. The research has some reference for similar enterprises in purchasing portfolio decision.

32 CFR 644.114 - Acquisition by declaration of taking.

Code of Federal Regulations, 2012 CFR

2012-07-01

... amount for the entire interest holding to have added value, for operational or other reasons, because it... determination be made as to whether the value of growing crops should be added to the value of the land... purchase due to failure to reach an agreement with the owners as to value, inability to contact the owners...

32 CFR 644.114 - Acquisition by declaration of taking.

Code of Federal Regulations, 2014 CFR

2014-07-01

... amount for the entire interest holding to have added value, for operational or other reasons, because it... determination be made as to whether the value of growing crops should be added to the value of the land... purchase due to failure to reach an agreement with the owners as to value, inability to contact the owners...

32 CFR 644.114 - Acquisition by declaration of taking.

Code of Federal Regulations, 2013 CFR

2013-07-01

... amount for the entire interest holding to have added value, for operational or other reasons, because it... determination be made as to whether the value of growing crops should be added to the value of the land... purchase due to failure to reach an agreement with the owners as to value, inability to contact the owners...

12 CFR 3.210 - Standardized measurement method for specific risk

Code of Federal Regulations, 2014 CFR

2014-01-01

... purchased credit protection is capped at the current fair value of the transaction plus the absolute value... specific risk add-on of zero if: (i) The debt or securitization position is fully hedged by a total return... absolute value of the current fair value of each net long or net short debt or securitization position in...

Purchasing health services abroad: practices of cross-border contracting and patient mobility in six European countries.

PubMed

Glinos, Irene A; Baeten, Rita; Maarse, Hans

2010-05-01

Contracting health services outside the public, statutory health system entails purchasing capacity from domestic non-public providers or from providers abroad. Over the last decade, these practices have made their way into European health systems, brought about by performance-oriented reforms and EU principles of free movement. The aim of the article is to explain the development, functioning, purposes and possible implications of cross-border contracting. Primary and secondary sources on purchasing from providers abroad have been collected in a systematic way and analysed in a structured frame. We found practices in six European countries. The findings suggest that purchasers from benefit-in-kind systems contract capacity abroad when this responds to unmet demand; pressures domestic providers; and/or offers financial advantages, especially where statutory purchasers compete. Providers which receive patients tend to be located in countries where treatment costs are lower and/or where providers compete. The modalities of purchasing and delivering care abroad vary considerably depending on contracts being centralised or direct, the involvement of middlemen, funding and pricing mechanisms, cross-border pathways and volumes of patient flows. The arrangements and concepts which cross-border contracting relies on suggest that statutory health purchasers, under pressure to deliver value for money and striving for cost-efficiency, experiment with new ways of organising health services for their populations. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.

Graphics supercomputer for computational fluid dynamics research

NASA Astrophysics Data System (ADS)

Liaw, Goang S.

1994-11-01

The objective of this project is to purchase a state-of-the-art graphics supercomputer to improve the Computational Fluid Dynamics (CFD) research capability at Alabama A & M University (AAMU) and to support the Air Force research projects. A cutting-edge graphics supercomputer system, Onyx VTX, from Silicon Graphics Computer Systems (SGI), was purchased and installed. Other equipment including a desktop personal computer, PC-486 DX2 with a built-in 10-BaseT Ethernet card, a 10-BaseT hub, an Apple Laser Printer Select 360, and a notebook computer from Zenith were also purchased. A reading room has been converted to a research computer lab by adding some furniture and an air conditioning unit in order to provide an appropriate working environments for researchers and the purchase equipment. All the purchased equipment were successfully installed and are fully functional. Several research projects, including two existing Air Force projects, are being performed using these facilities.

Hipoglicemiantes Orais Para Diabetes Mellitus Tipo 2: Comparação de Preços no Brasil e em Outros Sistemas Universais de Saúde.

PubMed

de Oliveira, Gustavo L A; Izidoro, Jans B; Ferré, Felipe; E Sousa, Samuel R A; Acurcio, Francisco A

2018-06-20

To estimate the average price of oral hypoglycemic agents provided by the Brazilian health system (SUS) and to compare them to other public health systems. Cross-sectional study about drug prices purchased by Belo Horizonte (municipal level), Minas Gerais (state level) and federal institutions in January and February of 2014. Average prices were calculated by defined daily dosage (DDD) and were compared to the management levels and the program "Aqui Tem Farmácia Popular" (ATFP). For international comparison, reimbursement values from Spain, Portugal, the United Kingdom and Canada (Province of Quebec) were used. Belo Horizonte had higher average prices than Minas Gerais. In general, essential oral hypoglycemic agents purchased by the SUS had lower prices than ATFP. For example, glibenclamide 5 mg was 1.023% more expensive. Metformin purchased by ATFP was more expensive than by SUS. Eight drugs purchased by SUS had average values above the respective Brazilian price ceiling. As an international comparison, SUS had lower average prices for glibenclamide and metformin. In ATFP, metformin was more expensive than in other countries, while glibenclamide was cheaper than Portugal only. The municipal management level had higher average prices than state level. Oral hypoglycemic agents purchased by SUS are predominantly cheaper than ATFP. Average prices paid by SUS are lower, while the prices paid by ATFP are higher than the reimbursed amounts from other countries. Copyright © 2018. Published by Elsevier Inc.

21 CFR 1314.100 - Sales limits for mail-order sales.

Code of Federal Regulations, 2010 CFR

2010-04-01

... a single calendar day sell to any purchaser more than 3.6 grams of ephedrine base, 3.6 grams of pseudoephedrine base, or 3.6 grams of phenylpropanolamine base in scheduled listed chemical products. (b) Each... any 30-day period sell to an individual purchaser more than 7.5 grams of ephedrine base, 7.5 grams of...

21 CFR 1314.100 - Sales limits for mail-order sales.

Code of Federal Regulations, 2013 CFR

2013-04-01

... a single calendar day sell to any purchaser more than 3.6 grams of ephedrine base, 3.6 grams of pseudoephedrine base, or 3.6 grams of phenylpropanolamine base in scheduled listed chemical products. (b) Each... any 30-day period sell to an individual purchaser more than 7.5 grams of ephedrine base, 7.5 grams of...

21 CFR 1314.100 - Sales limits for mail-order sales.

Code of Federal Regulations, 2014 CFR

2014-04-01

... a single calendar day sell to any purchaser more than 3.6 grams of ephedrine base, 3.6 grams of pseudoephedrine base, or 3.6 grams of phenylpropanolamine base in scheduled listed chemical products. (b) Each... any 30-day period sell to an individual purchaser more than 7.5 grams of ephedrine base, 7.5 grams of...

21 CFR 1314.100 - Sales limits for mail-order sales.

Code of Federal Regulations, 2011 CFR

2011-04-01

... a single calendar day sell to any purchaser more than 3.6 grams of ephedrine base, 3.6 grams of pseudoephedrine base, or 3.6 grams of phenylpropanolamine base in scheduled listed chemical products. (b) Each... any 30-day period sell to an individual purchaser more than 7.5 grams of ephedrine base, 7.5 grams of...

21 CFR 1314.100 - Sales limits for mail-order sales.

Code of Federal Regulations, 2012 CFR

2012-04-01

... a single calendar day sell to any purchaser more than 3.6 grams of ephedrine base, 3.6 grams of pseudoephedrine base, or 3.6 grams of phenylpropanolamine base in scheduled listed chemical products. (b) Each... any 30-day period sell to an individual purchaser more than 7.5 grams of ephedrine base, 7.5 grams of...

Price-Transparency and Cost Accounting

PubMed Central

Eakin, Cynthia; Fischer, Katrina

2015-01-01

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

Engaging with economic evaluation methods: insights from small and medium enterprises in the UK medical devices industry after training workshops.

PubMed

Craven, Michael P; Allsop, Matthew J; Morgan, Stephen P; Martin, Jennifer L

2012-09-03

With increased governmental interest in value assessment of technologies and where medical device manufacturers are finding it increasingly necessary to become more familiar with economic evaluation methods, the study sought to explore the levels of health economics knowledge within small and medium-sized enterprises (SMEs) and to scope strategies they employ to demonstrate the value of their products to purchasers. A short questionnaire was completed by participants attending one of five workshops on product development in the medical device sector that took place in England between 2007 and 2011. From all responses obtained, a large proportion of participants were based in SMEs (N = 43), and these responses were used for the analysis. Statistical analysis using non-parametric tests was performed on questions with approximately interval scales. Qualitative data from participant responses were analysed to reveal emerging themes. The questionnaire results revealed that 60% of SME participants (mostly company directors or managers, including product or project managers) rated themselves as having low or no knowledge of health economics prior to the workshops but the rest professed at least medium knowledge. Clinical trials and cost analyses or cost-effectiveness studies were the most highly cited means by which SMEs aim to demonstrate value of products to purchasers. Purchasers were perceived to place most importance on factors of safety, expert opinion, cost-effectiveness and price. However many companies did not utilise formal decision-making tools to prioritise these factors. There was no significant dependence of the use of decision-making tools in general with respect to professed knowledge of health economics methods. SMEs did not state a preference for any particular aspect of potential value when deciding whether to develop a product. A majority of SMEs stated they would use a health economics tool. Research and development teams or marketing and sales departments would most likely use one. This study points to the need for further research into the education requirements of SMEs in the area of Health Technology Assessment (HTA) and also for investigation into how SMEs engage with existing HTA processes as required by assessors such as NICE.

Engaging with economic evaluation methods: insights from small and medium enterprises in the UK medical devices industry after training workshops

PubMed Central

2012-01-01

Background With increased governmental interest in value assessment of technologies and where medical device manufacturers are finding it increasingly necessary to become more familiar with economic evaluation methods, the study sought to explore the levels of health economics knowledge within small and medium-sized enterprises (SMEs) and to scope strategies they employ to demonstrate the value of their products to purchasers. Methods A short questionnaire was completed by participants attending one of five workshops on product development in the medical device sector that took place in England between 2007 and 2011. From all responses obtained, a large proportion of participants were based in SMEs (N = 43), and these responses were used for the analysis. Statistical analysis using non-parametric tests was performed on questions with approximately interval scales. Qualitative data from participant responses were analysed to reveal emerging themes. Results The questionnaire results revealed that 60% of SME participants (mostly company directors or managers, including product or project managers) rated themselves as having low or no knowledge of health economics prior to the workshops but the rest professed at least medium knowledge. Clinical trials and cost analyses or cost-effectiveness studies were the most highly cited means by which SMEs aim to demonstrate value of products to purchasers. Purchasers were perceived to place most importance on factors of safety, expert opinion, cost-effectiveness and price. However many companies did not utilise formal decision-making tools to prioritise these factors. There was no significant dependence of the use of decision-making tools in general with respect to professed knowledge of health economics methods. SMEs did not state a preference for any particular aspect of potential value when deciding whether to develop a product. A majority of SMEs stated they would use a health economics tool. Research and development teams or marketing and sales departments would most likely use one. Conclusion This study points to the need for further research into the education requirements of SMEs in the area of Health Technology Assessment (HTA) and also for investigation into how SMEs engage with existing HTA processes as required by assessors such as NICE. PMID:22943625

Acceptance and purchase intent of US consumers for nonwheat rice butter cakes.

PubMed

Sae-Eaw, A; Chompreeda, P; Prinyawiwatkul, W; Haruthaithanasan, V; Suwonsichon, T; Saidu, J E; Xu, Z

2007-03-01

This study evaluated consumer acceptance and purchase intent of nonwheat butter cake formulations prepared with Thai jasmine rice flour. Three nonwheat rice butter cakes were prepared with varying amounts of powdered emulsifier (propylene glycol ester:diacetyl tartaric acid ester of monoglyceride, 8:2) at 0% (product A), 7.5% (product B), and 15% (product C) of the margarine content (15%) in the cake formulation. A commercial wheat-based butter cake served as the control. Consumers (n= 400) evaluated acceptability of 9 sensory attributes using a 9-point hedonic scale. Overall acceptance and purchase intent were determined with a binomial (yes/no) scale. At least 81% of consumers accepted products B and C, of which 42.1% and 47%, respectively, would purchase the products if commercially available. Product A was neither liked nor disliked with an overall liking score of 5.39. The butter cake products were differentiated by textural acceptability (overall texture, softness, and moistness) with a canonical correlation of 0.71 to 0.79. Overall liking and taste influenced overall acceptance and purchase intent. Odor influenced purchase intent (P= 0.0014), but not overall acceptance. The odds ratio of overall liking was 3.462 for purchase intent, indicating the probability of the product being purchased is 3.462 times higher (than not being purchased, P < 0.0001) with every 1-unit increase of the overall liking score. Based on the logit model, overall acceptance and purchase intent could be predicted with 89.3% and 83.3% accuracy, respectively. The study demonstrated feasibility of completely substituting wheat flour with Thai jasmine rice flour for production of butter cake products acceptable to American consumers.

An analysis of 1986 drug procurement practices in hospitals within the United States.

PubMed

Smolarek, R T; Powell, M F; Solomon, D K; Boike, S C

1989-09-01

The purpose of this study was to statistically answer a set of predefined objectives concerning pharmaceutical procurement. The key indicators were assumed to be cost per patient day and turnover rate. Of the 5,911 surveys mailed, 709 surveys were returned for a 12% response rate. The following statements were based on attempts to answer the six predetermined objectives. Pharmaceutical purchasing is controlled by pharmacy departments to the extent that comparisons to pharmaceutical purchasing by materials management departments was not possible. Prime vendor purchasing is the procurement method of choice. Competitive bidding through a group process is so popular that a valid comparison to nongroup bidding could not be accomplished with the results of this survey. Certain variables of group purchasing such as group age, contract adherence, and volume commitment, do not appear to be correlated to purchasing outcomes in this study. When comparing government to private hospitals, the private sector seems to have an advantage in managing turnover rates. Cost per patient day results were less conclusive. As single and multiple hospital systems were compared for purchasing outcomes, the results were not totally conclusive. Although, multiple hospital systems had a significantly higher turnover rate. Finally, a comparison based on the use, or lack of use, of prime vendor arrangements demonstrated interesting results. The duration of contract did not significantly affect the purchasing outcomes. Other hospital variables such as size, type, ownership, and organization, demonstrated notable trends. The importance of examining hospitals based on case mix and mission seems to be most important. Also, the ability to relate purchasing outcomes with formulary management strategies needs further study before conclusive statements can be adopted.

Effects of nutrient profiling and price changes based on NuVal® scores on food purchasing in an online experimental supermarket.

PubMed

Epstein, Leonard H; Finkelstein, Eric A; Katz, David L; Jankowiak, Noelle; Pudlewski, Corrin; Paluch, Rocco A

2016-08-01

The goal of the present study was to apply experimental economic methods in an online supermarket to examine the effects of nutrient profiling, and differential pricing based on the nutrient profile, on the overall diet quality, energy and macronutrients of the foods purchased, and diet cost. Participants were provided nutrient profiling scores or price adjustments based on nutrient profile scores while completing a hypothetical grocery shopping task. Prices of foods in the top 20 % of nutrient profiling scores were reduced (subsidized) by 25 % while those in the bottom 20 % of scores were increased (taxed) by 25 %. We evaluated the independent and interactive effects of nutrient profiling or price adjustments on overall diet quality of foods purchased as assessed by the NuVal® score, energy and macronutrients purchased and diet cost in a 2×2 factorial design. A large (>10 000 food items) online experimental supermarket in the USA. Seven hundred and eighty-one women. Providing nutrient profiling scores improved overall diet quality of foods purchased. Price changes were associated with an increase in protein purchased, an increase in energy cost, and reduced carbohydrate and protein costs. Price changes and nutrient profiling combined were associated with no unique benefits beyond price changes or nutrient profiling alone. Providing nutrient profile score increased overall NuVal® score without a reduction in energy purchased. Combining nutrient profiling and price changes did not show an overall benefit to diet quality and may be less useful than nutrient profiling alone to consumers who want to increase overall diet quality of foods purchased.

Strategies to advance vaccine technologies for resource-poor settings.

PubMed

Kristensen, Debra; Chen, Dexiang

2013-04-18

New vaccine platform and delivery technologies that can have significant positive impacts on the effectiveness, acceptability, and safety of immunizations in developing countries are increasingly available. Although donor support for vaccine technology development is strong, the uptake of proven technologies by the vaccine industry and demand for them by purchasers continues to lag. This article explains the challenges and opportunities associated with accelerating the availability of innovative and beneficial vaccine technologies to meet critical needs in resource-poor settings over the next decade. Progress will require increased dialog between the public and private sectors around vaccine product attributes; establishment of specifications for vaccines that mirror programmatic needs; stronger encouragement of vaccine developers to consider novel technologies early in the product development process; broader facilitation of research and access to technologies through the formation of centers of excellence; the basing of vaccine purchase decisions on immunization systems costs rather than price per dose alone; possible subsidization of early technology adoption costs for vaccine producers that take on the risks of new technologies of importance to the public sector; and the provision of data to purchasers, better enabling them to make informed decisions that take into account the value of specific product attributes. Copyright © 2012 Elsevier Ltd. All rights reserved.

7 CFR 623.9 - Easement priority.

Code of Federal Regulations, 2011 CFR

2011-01-01

... restored, (e) Wetland function or values, (f) Likelihood of successful restoration of wetland values, (g... AGRICULTURE WATER RESOURCES EMERGENCY WETLANDS RESERVE PROGRAM § 623.9 Easement priority. The State... government expenditure on restoration and easement purchase. The factors for determining the priority for...

How PV system ownership can impact the market value of residential homes

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

Klise, Geoffrey Taylor; Johnson, Jamie L.

2014-01-01

There are multiple ways for a homeowner to obtain the electricity generating and savings benefits offered by a photovoltaic (PV) system. These include purchasing a PV system through various financing mechanisms, or by leasing the PV system from a third party with multiple options that may include purchase, lease renewal or PV system removal. The different ownership options available to homeowners presents a challenge to appraisal and real estate professionals during a home sale or refinance in terms of how to develop a value that is reflective of the PV systems operational characteristics, local market conditions, and lender and underwritermore » requirements. This paper presents these many PV system ownership options with a discussion of what considerations an appraiser must make when developing the contributory value of a PV system to a residential property.« less

21 CFR 1314.20 - Restrictions on sales quantity.

Code of Federal Regulations, 2011 CFR

2011-04-01

... single calendar day sell any purchaser more than 3.6 grams of ephedrine base, 3.6 grams of pseudoephedrine base, or 3.6 grams of phenylpropanolamine base in scheduled listed chemical products. (b) A mobile retail vendor may not in any 30-day period sell an individual purchaser more than 7.5 grams of ephedrine...

21 CFR 1314.20 - Restrictions on sales quantity.

Code of Federal Regulations, 2013 CFR

2013-04-01

... single calendar day sell any purchaser more than 3.6 grams of ephedrine base, 3.6 grams of pseudoephedrine base, or 3.6 grams of phenylpropanolamine base in scheduled listed chemical products. (b) A mobile retail vendor may not in any 30-day period sell an individual purchaser more than 7.5 grams of ephedrine...

21 CFR 1314.20 - Restrictions on sales quantity.

Code of Federal Regulations, 2010 CFR

2010-04-01

... single calendar day sell any purchaser more than 3.6 grams of ephedrine base, 3.6 grams of pseudoephedrine base, or 3.6 grams of phenylpropanolamine base in scheduled listed chemical products. (b) A mobile retail vendor may not in any 30-day period sell an individual purchaser more than 7.5 grams of ephedrine...

21 CFR 1314.20 - Restrictions on sales quantity.

Code of Federal Regulations, 2014 CFR

2014-04-01

... single calendar day sell any purchaser more than 3.6 grams of ephedrine base, 3.6 grams of pseudoephedrine base, or 3.6 grams of phenylpropanolamine base in scheduled listed chemical products. (b) A mobile retail vendor may not in any 30-day period sell an individual purchaser more than 7.5 grams of ephedrine...

21 CFR 1314.20 - Restrictions on sales quantity.

Code of Federal Regulations, 2012 CFR

2012-04-01

... single calendar day sell any purchaser more than 3.6 grams of ephedrine base, 3.6 grams of pseudoephedrine base, or 3.6 grams of phenylpropanolamine base in scheduled listed chemical products. (b) A mobile retail vendor may not in any 30-day period sell an individual purchaser more than 7.5 grams of ephedrine...

Assessment of perception and intention in pesticide purchase in Taiwan.

PubMed

Yeh, Jong Chao; Liao, Chih-Hsiang

2016-05-01

Environmental chemical agents such as pesticides can be purchased easily at a relatively low price, and this has resulted in high concern of environmental toxicity to human health, due to their persistence in various environmental bodies. Hence, this study aims to propose important factors influencing pesticide purchase intentions, including consumers' perceptions of the brand image and the ecological health risk. Since consumers are primary users, the seller knows the product's features but not the psychology of those who purchase it. Therefore, we attempted to clarify purchase intentions and perceptions using structural equation modeling techniques to empirically analyze survey data from 324 pesticide consumers in Taiwan. Our results demonstrate that perceived brand image positively affects perceived quality of a product, whereas perceived risk negatively affects perceived quality and purchase intentions. Furthermore, this study provides evidence that perceived quality positively affects purchase intentions. These relationships suggest that perceived quality mediates both the positive association between brand image and purchase intentions and the negative association between perceived risk and purchase intentions. Based on such outcomes, we propose that consumers need to be informed of pesticides related to costs and environmental benefits.

A framework for understanding grocery purchasing in a low-income urban environment.

PubMed

Zachary, Drew A; Palmer, Anne M; Beckham, Sarah W; Surkan, Pamela J

2013-05-01

Research demonstrates that food desert environments limit low-income shoppers' ability to purchase healthy foods, thereby increasing their likelihood of diet-related illnesses. We sought to understand how individuals in an urban American food desert make grocery-purchasing decisions, and specifically why unhealthy purchases arise. Analysis is based on ethnographic data from participant observation, 37 in-depth interviews, and three focus groups with low-income, primarily African American shoppers with children. We found participants had detailed knowledge of and preference for healthy foods, but the obligation to consistently provide food for their families required them to apply specific decision criteria which, combined with structural qualities of the supermarket environment, increased unhealthy purchases and decreased healthy purchases. Applying situated cognition theory, we constructed an emic model explaining this widely shared grocery-purchasing decision process and its implications. This context-specific understanding of behavior suggests that multifaceted, system-level approaches to intervention are needed to increase healthy purchasing in food deserts.

Do processed vegetables reduce the socio-economic differences in vegetable purchases? A study in France.

PubMed

Plessz, Marie; Gojard, Séverine

2013-10-01

Vegetable consumption varies highly across households, based on household structure and socio-economic status, but little is known about the share of fresh vs. processed (e.g. frozen or canned) vegetables. Our aim was to compare the social and economic determinants of fresh and processed vegetable consumption. We reviewed detailed data on vegetable purchases for at-home consumption of 2600 French households during 2007. We took into account a wide range of processed vegetables (excluding potatoes) and made a distinction between fresh vegetables, processed vegetables and baby food containing vegetables. We conducted regression analyses to predict consumption of fresh and processed vegetables in kilograms per year and unit values in euros per kilogram. About 60% of the vegetables bought by the sample households were fresh. Fresh vegetable consumption increased with the respondent's income, age and educational level, and with the number of adults but not with the presence of children aged <6 years. The quantity of processed vegetables purchased increased with the household size but was not dependent on age, education or household income, although the richest households spent more per kilogram on processed vegetables. Households with a child aged <6 years also purchased 10 kg of baby foods containing vegetables. We found socio-economic inequalities in the quantities of fresh vegetables, in the spending on fresh and processed vegetables but not in the quantities of processed vegetables. This suggests that monitoring the price and nutritional quality of processed vegetables and providing this information to consumers could help them identify nutritious, affordable and convenient foods.

30 CFR 206.152 - Valuation standards-unprocessed gas.

Code of Federal Regulations, 2010 CFR

2010-07-01

.... Use the same value for volumes that exceed the over-delivery tolerances even if those volumes are... the value to be determined on the basis of a percentage of the purchaser's proceeds resulting from... section. (2) The value of production, for royalty purposes, of gas subject to this subpart shall be the...

12 CFR 703.11 - Valuing securities.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 12 Banks and Banking 7 2014-01-01 2014-01-01 false Valuing securities. 703.11 Section 703.11 Banks... DEPOSIT ACTIVITIES § 703.11 Valuing securities. (a) Before purchasing or selling a security, a Federal credit union must obtain either price quotations on the security from at least two broker-dealers or a...

12 CFR 324.210 - Standardized measurement method for specific risk.

Code of Federal Regulations, 2014 CFR

2014-01-01

... purchased credit protection is capped at the current fair value of the transaction plus the absolute value... hedge has a specific risk add-on of zero if: (i) The debt or securitization position is fully hedged by... debt or securitization positions, an FDIC-supervised institution must multiply the absolute value of...

14 CFR 1261.109 - Computation of allowance.

Code of Federal Regulations, 2011 CFR

2011-01-01

... to the loss or damage of property lost or damaged beyond economical repair, less any salvage value... price paid in cash or property, or the value at the time of acquisition if not acquired by purchase or exchange). There will be no allowance for replacement cost or for appreciation in the value of the property...

24 CFR 17.48 - Computation of amount of award.

Code of Federal Regulations, 2011 CFR

2011-04-01

... loss or damage, of property lost or damaged beyond economical repair, less any salvage value; or (2... property, or the value at the time of acquisition if not acquired by purchase or exchange); and there will be no allowance for replacement cost or for appreciation in the value of the property. Subject to...

20 CFR 362.12 - Computation of amount of reimbursement.

Code of Federal Regulations, 2011 CFR

2011-04-01

... paid in cash for the property or, if not acquired by purchase or exchange, the value at the time of acquisition. The amount normally payable on property damaged beyond economical repair is found by determining its depreciated value immediately before it was damaged or lost, less any salvage value. If the cost...

Purchases Made with a Fruit and Vegetable Voucher in a Rural Mexican-Heritage Community.

PubMed

Hanbury, Meagan M; Gomez-Camacho, Rosa; Kaiser, Lucia; Sadeghi, Banafsheh; de la Torre, Adela

2017-10-01

Recent recommendations for US food assistance programs are intended to ensure foods provided through these programs help households consume a varied, healthful diet. From a policy viewpoint, it is important to examine the impact of economic incentives to purchase healthy foods across subpopulations, particularly low-income Latinos, who comprise 40% of the WIC program nationwide. Our aim was to determine how rural, Mexican-heritage households (N = 227) residing in California's Central Valley distributed fruit and vegetable (F/V) voucher spending among F/V subgroups and specific items over a 1-year period. Households contained at least one child who was between 3 and 8 years old at baseline and had a parent of Mexican-heritage. F/V voucher purchase data were collected via grocery store scanners. Expenditure and frequency shares of subgroups and individual items were analyzed to determine purchasing habits. Fruits were the most commonly purchased subgroup, representing 55% of spending and 45% of frequency. Households allocated low percentages of their voucher to dark green and red/orange vegetables-7 and 9% respectively. Approximately 20% of purchases were good potassium sources and 30% of purchases were good fiber sources. Many of the most frequently purchased items were of cultural significance (tomatillo, chayote, chili/jalapeño pepper, and Mexican squash). This study suggests that economic incentives can contribute important nutrients to participants' diets and targeted vouchers provided by food assistance programs should continue to include culturally important foods and be aware of the cultural values of their participants.

Behavioral economic substitutability of e-cigarettes, tobacco cigarettes, and nicotine gum.

PubMed

Johnson, Matthew W; Johnson, Patrick S; Rass, Olga; Pacek, Lauren R

2017-07-01

The public health impact of e-cigarettes may depend on their substitutability for tobacco cigarettes. Dual users of e-cigarettes and tobacco cigarettes completed purchasing tasks in which they specified daily use levels under hypothetical conditions that varied the availability and price of e-cigarettes, tobacco cigarettes, and nicotine gum (for those with nicotine gum experience). When either e-cigarettes or tobacco cigarettes were the only available commodity, as price per puff increased, purchasing decreased, revealing similar reinforcement profiles. When available concurrently, as the price of tobacco puffs increased, purchasing of tobacco puffs decreased while purchasing of fixed-price e-cigarette puffs increased. Among those with nicotine gum experience, when the price of tobacco puffs was closest to the actual market value of tobacco puffs, e-cigarette availability decreased median tobacco puff purchases by 44% compared to when tobacco was available alone. In contrast, nicotine gum availability caused no decrease in tobacco puff purchases. E-cigarettes may serve as a behavioral economic substitute for tobacco cigarettes, and may be a superior substitute compared to nicotine gum in their ability to decrease tobacco use. Although important questions remain regarding the health impacts of e-cigarettes, these data are consistent with the possibility that e-cigarettes may serve as smoking cessation/reduction aids.

Development of measures assessing attitudes toward contraband tobacco among a web-based sample of smokers.

PubMed

Adkison, Sarah E; O'Connor, Richard J; Chaiton, Michael; Schwartz, Robert

2015-01-01

As regulation of tobacco products tightens, there are concerns that illicit markets may develop to supply restricted products. However, there are few validated measures to assess attitudes or purchase intentions toward contraband tobacco (CT). As such, it is important to investigate individual level characteristics that are associated with the purchase and use of contraband tobacco. In May 2013, a pilot survey assessed attitudes, behaviors, and purchase intentions for contraband tobacco based on previous research regarding non-tobacco contraband. The survey was administered via Amazon Mechanical Turk, a crowdsourcing resource, among current smoking respondents in the United States and Canada. Structural equation modeling was used to evaluate the validity of the proposed model for understanding attitudes toward contraband tobacco. CT purchasers were more likely to report norms supportive of counterfeit products, more intentions toward purchasing counterfeit products, a lowered risk associated with these products, and to have more favorable attitudes toward CT than those who had not purchased CT. Attitudes toward CT mediated the relationship between subjective norms and prior purchase with behavior intentions. Perceived risk had a significant direct effect on intentions and an indirect effect through attitudes toward CT. The structural model fit the data well and accounted for over half (53%) of the variance in attitudes toward tobacco. Understanding the mechanisms associated with CT attitudes and purchase behaviors may provide insight for how to mitigate possible iatrogenic consequences of newly implemented regulations. The measures developed here elucidate some elements that influence attitudes and purchase intentions for CT and may inform policy efforts to curtail the development of illicit markets.

Is a share buyback right for your company?

PubMed

Pettit, J

2001-04-01

Contrary to popular wisdom, buybacks don't create value by raising earnings per share. But they do indeed create value, and in two very different ways. First, a buyback sends signals about the company's prospects to the market--hopefully, that prospects are so good that the best investment managers can make right now is in their own company. But investors won't see it that way if other, negative, signals are coming from the company, and it's rarely a good idea for companies in high-growth industries, where investors expect that money to be spent pursuing new opportunities. Second, when financed as a debt issue, a buyback is essentially an exchange of equity for debt, conferring the traditional benefits of leverage--a tax shield and a discipline for managers. For such a buyback to make sense, a company would need to have taxable profits in need of shielding, of course, and be able to predict its future cash flows fairly accurately. Justin Pettit has found that managers routinely underestimate how many shares they need to buy to send a credible signal to the markets, and he offers a way to calculate that number. He also goes through the iterative steps involved in working out how many shares must be purchased to reach a target level of debt. Then he takes a look at the advantages and disadvantages of the three most common ways that companies make the actual purchases--open-market purchases, fixed-price tender offers, and auction-based tender offers. When a company's performance is lagging, a share buyback can look attractive. Unfortunately, a buyback can backfire--unless executives understand why, when, and how to use this powerful and risky tool.

Strategies for price reduction of HIV medicines under a monopoly situation in Brazil

PubMed Central

Chaves, Gabriela Costa; Hasenclever, Lia; Osorio-de-Castro, Claudia Garcia Serpa; Oliveira, Maria Auxiliadora

2016-01-01

ABSTRACT OBJECTIVE To analyze Government strategies for reducing prices of antiretroviral medicines for HIV in Brazil. METHODS Analysis of Ministry of Health purchases of antiretroviral medicines, from 2005 to 2013. Expenditures and costs of the treatment per year were analyzed and compared to international prices of atazanavir. Price reductions were estimated based on the terms of a voluntary license of patent rights and technology transfer in the Partnership for Productive Development Agreement for atazanavir. RESULTS Atazanavir, a patented medicine, represented a significant share of the expenditures on antiretrovirals purchased from the private sector. Prices in Brazil were higher than international references, and no evidence was found of a relationship between purchase volume and price paid by the Ministry of Health. Concerning the latest strategy to reduce prices, involving local production of the 200 mg capsule, the price reduction was greater than the estimated reduction. As for the 300 mg capsule, the amounts paid in the first two years after the Partnership for Productive Development Agreement were close to the estimated values. Prices in nominal values for both dosage forms remained virtually constant between 2011 (the signature of the Partnership for Productive Development Agreement), 2012 and 2013 (after the establishment of the Partnership). CONCLUSIONS Price reduction of medicines is complex in limited-competition environments. The use of a Partnership for Productive Development Agreement as a strategy to increase the capacity of local production and to reduce prices raises issues regarding its effectiveness in reducing prices and to overcome patent barriers. Investments in research and development that can stimulate technological accumulation should be considered by the Government to strengthen its bargaining power to negotiate medicines prices under a monopoly situation. PMID:26759969

Capturing the spectrum of household food and beverage purchasing behavior: a review.

PubMed

French, Simone A; Shimotsu, Scott T; Wall, Melanie; Gerlach, Anne Faricy

2008-12-01

The household setting may be the most important level at which to understand the food choices of individuals and how healthful food choices can be promoted. However, there are few available measures of the food purchase behaviors of households and little consensus on the best way to measure it. This review explores the currently available measures of household food purchasing behavior. Three main measures are described, evaluated, and compared: home food inventories, food and beverage purchase records and receipts, and Universal Product Code bar code scanning. The development of coding, aggregation, and analytical methods for these measures of household food purchasing behavior is described. Currently, annotated receipts and records are the most comprehensive, detailed measure of household food purchasing behavior, and are feasible for population-based samples. Universal Product Code scanning is not recommended due to its cost and complexity. Research directions to improve household food purchasing behavior measures are discussed.

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

PubMed

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

2017-08-24

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

Comparison of two front-of-package nutrition labeling schemes, and their explanation, on consumers' perception of product healthfulness and food choice.

PubMed

Lundeberg, Pamela J; Graham, Dan J; Mohr, Gina S

2018-06-01

Front-of-package (FOP) nutrition labels are increasingly used to present nutritional information to consumers. A variety of FOP nutrition schemes exist for presenting condensed nutrition information. The present study directly compared two symbolic FOP labeling systems - traffic light and star-based schemes - with specific regard to healthfulness perception and purchase intention for a variety of products. Additionally, this study investigated which method of message framing (gain, loss, gain + loss) would best enable individuals to effectively utilize the FOP labels. College students (n = 306) viewed food packages featuring either star or traffic light FOP labels and rated the healthfulness of each product and their likelihood of purchasing the product. Within each label type, participants were presented with differently-framed instructions regarding how to use the labels. Participants who viewed the star labels rated products with the lowest healthfulness as significantly less healthful and rated products with the highest healthfulness as significantly more healthful compared to participants who viewed those same products with traffic light labels. Purchase intention did not differ by label type. Additionally, including any type of framing (gain, loss, or gain + loss) assisted consumers in differentiating between foods with mid-range vs. low nutritional value. Star-based labels led more healthful foods to be seen as even more healthful and less healthful foods to be seen as even less healthful compared to the same foods with traffic light labels. Additionally, results indicate a benefit of including framing information for FOP nutrition label instructions; however, no individual frame led to significantly different behavior compared to the other frames. While ratings of product healthfulness were influenced by the framing and the label type, purchase intention was not impacted by either of these factors. Copyright © 2018 Elsevier Ltd. All rights reserved.

Parental Characteristics and Reasons Associated With Purchasing Kids' Meals for Their Children.

PubMed

Lee-Kwan, Seung Hee; Park, Sohyun; Maynard, Leah M; Blanck, Heidi M; McGuire, Lisa C; Collins, Janet L

2018-02-01

Characteristics of parents who purchased kids' meals, reasons for the purchase, and desire for healthy options were examined. Quantitative, cross-sectional study. National. The SummerStyles survey data of 1147 parents (≥18 years). Self-reported outcome variables were purchase of kids' meals (yes/no), reasons for the purchase (13 choices), and desire for healthy options (yes/no). We used multivariable logistic regression to estimate odds ratios (ORs) for purchasing kids' meals based on parental sociodemographic and behavioral characteristics. Over half (51%) of parents reported purchasing kids' meals in the past month. The adjusted OR of purchasing kids' meals were significantly higher among younger parents (OR = 3.44 vs ≥50 years) and among parents who consumed sugar-sweetened beverages (SSBs) daily (OR = 2.70 vs none). No differences were found for race/ethnicity, income, and education. Parents who purchased kids' meals reported that the top 3 reasons for purchase were (1) because their children asked for kids' meals, (2) habit, and (3) offering of healthier sides such as fruits or fruit cups. Thirty-seven percent of parents who did not purchase kids' meals expressed willingness to purchase kids' meals if healthy options were available; this willingness was highest among younger parents (47%; P < .05). Kids' meal purchases were somewhat common. Our findings on characteristics of parents who frequently bought kids' meals (ie, younger parents and SSB consumers), common reasons for purchasing kids' meals, and willingness to buy healthier kids' meal can be used to inform intervention efforts to improve quality of kids' meals.

Scaling-up strategic purchasing: analysis of health system governance imperatives for strategic purchasing in a free maternal and child healthcare programme in Enugu State, Nigeria.

PubMed

Ogbuabor, Daniel Chukwuemeka; Onwujekwe, Obinna Emmanuel

2018-04-05

Significant knowledge gaps exist in the functioning of institutional designs and organisational practices in purchasing within free healthcare schemes in low resource countries. The study provides evidence of the governance requirements to scale up strategic purchasing in free healthcare policies in Nigeria and other low-resource settings facing similar approaches. The study was conducted at the Ministry of Health and in two health districts in Enugu State, Nigeria, using a qualitative case study design. Semi-structured interviews were conducted with 44 key health system actors (16 policymakers, 16 providers and 12 health facility committee leaders) purposively selected from the Ministry of Health and the two health districts. Data collection and analysis were guided by Siddiqi and colleagues' health system governance framework. Data were analysed using a framework approach. The key findings show that supportive governance practices in purchasing included systems to verify questionable provider claims, pay providers directly for services, compel providers to procure drugs centrally and track transfer of funds to providers. However, strategic vision was undermined by institutional conflicts, absence of purchaser-provider split and lack of selective contracting of providers. Benefit design was not based on stakeholder involvement. Rule of law was limited by delays in provider payment. Benefits and obligations to users were not transparent. The criteria and procedure for resource allocation were unclear. Some target beneficiaries seemed excluded from the scheme. Effectiveness and efficiency was constrained by poor adherence to purchasing rules. Accountability of purchasers and providers to users was weak. Intelligence and information is constrained by paper-based system. Rationing of free services by providers and users' non-adherence to primary gate-keeping role hindered ethics. Weak governance of purchasing function limits potential of FMCHP to contribute towards universal health coverage. Appropriate governance model for strengthening strategic purchasing in the FMCHP and possibly free healthcare interventions in other low-resource countries must pay attention to the creation of an autonomous purchasing agency, clear framework for selective contracting, stakeholder involvement, transparent benefit design, need-based resource allocation, efficient provider payment methods, stronger roles for citizens, enforcement of gatekeeping rules and use of data for decision-making.

Medicare and Medicaid Programs; CY 2016 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements. Final rule.

PubMed

2015-11-05

This final rule will update Home Health Prospective Payment System (HH PPS) rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor under the Medicare prospective payment system for home health agencies (HHAs), effective for episodes ending on or after January 1, 2016. As required by the Affordable Care Act, this rule implements the 3rd year of the 4-year phase-in of the rebasing adjustments to the HH PPS payment rates. This rule updates the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking and provides a clarification regarding the use of the "initial encounter'' seventh character applicable to certain ICD-10-CM code categories. This final rule will also finalize reductions to the national, standardized 60-day episode payment rate in CY 2016, CY 2017, and CY 2018 of 0.97 percent in each year to account for estimated case-mix growth unrelated to increases in patient acuity (nominal case-mix growth) between CY 2012 and CY 2014. In addition, this rule implements a HH value-based purchasing (HHVBP) model, beginning January 1, 2016, in which all Medicare-certified HHAs in selected states will be required to participate. Finally, this rule finalizes minor changes to the home health quality reporting program and minor technical regulations text changes.

Agreement between PRE2DUP register data modeling method and comprehensive drug use interview among older persons

PubMed Central

Taipale, Heidi; Tanskanen, Antti; Koponen, Marjaana; Tolppanen, Anna-Maija; Tiihonen, Jari; Hartikainen, Sirpa

2016-01-01

Background PRE2DUP is a modeling method that generates drug use periods (ie, when drug use started and ended) from drug purchases recorded in dispensing-based register data. It is based on the evaluation of personal drug purchasing patterns and considers hospital stays, possible stockpiling of drugs, and package information. Objective The objective of this study was to investigate person-level agreement between self-reported drug use in the interview and drug use modeled from dispensing data with PRE2DUP method for various drug classes used by older persons. Methods Self-reported drug use was assessed from the GeMS Study including a random sample of persons aged ≥75 years from the city of Kuopio, Finland, in 2006. Drug purchases recorded in the Prescription register data of these persons were modeled to determine drug use periods with PRE2DUP modeling method. Agreement between self-reported drug use on the interview date and drug use calculated from register-based data was compared in order to find the frequently used drugs and drug classes, which was evaluated by Cohen’s kappa. Kappa values 0.61–0.80 were considered to represent good and 0.81–1.00 as very good agreement. Results Among 569 participants with mean age of 82 years, the agreement between interview and register data was very good for 75% and very good or good for 93% of the studied drugs or drug classes. Good or very good agreement was observed for drugs that are typically used on regular bases, whereas “as needed” drugs represented poorer results. Conclusion PRE2DUP modeling method validly describes regular drug use among older persons. For most of drug classes investigated, PRE2DUP-modeled register data described drug use as well as interview-based data which are more time-consuming to collect. Further studies should be conducted by comparing it with other methods and in different drug user populations. PMID:27785101

Who Purchases Low-Cost Alcohol in Australia?

PubMed

Callinan, Sarah; Room, Robin; Livingston, Michael; Jiang, Heng

2015-11-01

Debates surrounding potential price-based polices aimed at reducing alcohol-related harms tend to focus on the debate concerning who would be most affected-harmful or low-income drinkers. This study will investigate the characteristics of people who purchase low-cost alcohol using data from the Australian arm of the International Alcohol Control study. 1681 Australians aged 16 and over who had consumed alcohol and purchased it in off-licence premises were asked detailed questions about both practices. Low-cost alcohol was defined using cut-points of 80¢, $1.00 or $1.25 per Australian standard drink. With a $1.00 cut-off low income (OR = 2.1) and heavy drinkers (OR = 1.7) were more likely to purchase any low-cost alcohol. Harmful drinkers purchased more, and low-income drinkers less, alcohol priced at less than $1.00 per drink than high income and moderate drinkers respectively. The relationship between the proportion of units purchased at low cost and both drinker category and income is less clear, with hazardous, but not harmful, drinkers purchasing a lower proportion of units at low cost than moderate drinkers. The impact of minimum pricing on low income and harmful drinkers will depend on whether the proportion or total quantity of all alcohol purchased at low cost is considered. Based on absolute units of alcohol, minimum unit pricing could be differentially effective for heavier drinkers compared to other drinkers, particularly for young males. © The Author 2015. Medical Council on Alcohol and Oxford University Press. All rights reserved.

Estimating the Reliability of the CITAR Computer Courseware Evaluation System.

ERIC Educational Resources Information Center

Micceri, Theodore

In today's complex computer-based teaching (CBT)/computer-assisted instruction market, flashy presentations frequently prove the most important purchasing element, while instructional design and content are secondary to form. Courseware purchasers must base decisions upon either a vendor's presentation or some published evaluator rating.…

Nanofluidic Lab-On-Chip Technology for DNA Identification

DTIC Science & Technology

2013-09-30

samples Fluorescently labeled (FAM tag) DNA oligomers (10, 20, and 50 bases long) were purchased with standard desalting and additional HPLC purification...A.2 DNA samples: DNA oligomers (10, 20, 50 nt long) were purchased with standard desalting and additional HPLC purification for the 50 base

Sustainable competitive advantage for accountable care organizations.

PubMed

Macfarlane, Michael Alex

2014-01-01

In the current period of health industry reform, accountable care organizations (ACOs) have emerged as a new model for the delivery of high-quality and cost-effective healthcare. However, few ACOs operate in direct competition with one another, and the accountable care business model has yet to present a means of continually developing new marginal value for patients and network partners. With value-based purchasing and patient consumerism strengthening as market forces, ACOs must build organizational sustainability and competitive advantage to meet the value demands set by customers and competitors. This essay proposes a strategy, adapted from the disciplines of agile software development and Lean product development, through which ACOs can engage internal and external customers in the development of new products that will provide sustainability and competitive advantage to the organization by decreasing waste in development, promoting specialized knowledge, and closely targeting customer value.

The mere green effect: An fMRI study of pro-environmental advertisements.

PubMed

Vezich, I Stephanie; Gunter, Benjamin C; Lieberman, Matthew D

2017-08-01

Self-report evidence suggests that consumers prefer green products (i.e., pro-environmental) to standard products, but this is not reflected in purchase behaviors. To understand this disconnect, we exposed participants in a magnetic resonance imaging (MRI) scanner to green and standard ads. After viewing each ad, participants rated liking and perceived sustainability. Ratings were more favorable for green ads than for control ads, but the functional MRI data suggested an opposite pattern-participants showed greater activation in regions associated with personal value and reward (ventromedial prefrontal cortex and ventral striatum) in response to control ads relative to green ads. In addition, participants showed greater activity in these regions to the extent that they reported liking control ads, but there was no such trend for green ads. In line with a neuroeconomic account, we suggest that activity in these regions may be indexing a value signal computed during message exposure that may influence downstream purchase decisions, in contrast to self-reported evaluations that may reflect social desirability concerns absent at the point of purchase.

Monitoring changes in the nutritional content of ready-to-eat grain-based dessert products manufactured and purchased between 2005 and 2012.

PubMed

Mathias, Kevin C; Ng, Shu Wen; Popkin, Barry

2015-03-01

Monitoring changes in the nutritional content of food/beverage products and shifts in consumer purchasing behaviors is needed to measure the effectiveness of efforts by both food manufacturers and policy makers to improve dietary quality in the United States. To examine changes in the nutritional content (eg, energy, saturated fat, and sugar density) of ready-to-eat (RTE) grain-based dessert (GBD) products manufactured and purchased between 2005 and 2012. Nutrition Facts panel information from commercial databases was linked to RTE GBD products purchased by households (N=134,128) in the Nielsen Homescan longitudinal dataset 2005-2012. Linear regression models were used to examine changes in the energy, saturated fat, and sugar density of RTE GBD products manufactured in each year between 2005 and 2012. Random effects models controlling for demographics, household composition/size, and geographic location were used to examine changes in household purchases of RTE GBD products (in grams) and the average energy, saturated fat, and sugar density of RTE GBD products purchased. The saturated fat density (grams/100 g) of RTE GBD products increased significantly from 6.5±0.2 in 2005 to 7.3±0.2 and 7.9±0.2 for pre-existing and newly introduced products in 2012, respectively. Between 2005 and 2012, the energy density (kilocalories/100 g) of RTE GBD products purchased decreased significantly from 433±0.2 to 422±0.2, the saturated fat density (grams/100 g) of products purchased increased significantly from 6.3±0.01 to 6.6±0.01, the sugar density (grams/100 g) of products purchased decreased significantly from 32.4±0.03 to 31.3±0.02, and household purchases of RTE GBD products (in grams) decreased by 24.1%±0.4%. These results highlight an opportunity for both food manufacturers and public health officials to develop new strategies to shift consumer purchases toward products with lower energy, saturated fat, and sugar densities in addition to decreasing overall purchases of RTE GBDs. Copyright © 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Monitoring Changes in the Nutritional Content of Ready-To-Eat Grain-Based Dessert Products Manufactured and Purchased Between 2005 and 2012

PubMed Central

Mathias, Kevin C.; Wen, Shu; Popkin, Barry; Kenan, W.R.

2014-01-01

Background Monitoring changes in the nutritional content of food/beverage products and shifts in consumer purchasing behaviors is needed to measure the effectiveness of efforts by both food manufacturers and policy makers to improve dietary quality in the United States. Objective Examine changes in the nutritional content (e.g., energy, saturated fat, and sugar density) of Ready-To-Eat (RTE) Grain-Based Dessert (GBD) products manufactured and purchased between 2005 and 2012. Design Nutrition facts panel information from commercial databases was linked to RTE GBD products purchased by households (n=134,128) in the Nielsen Homescan longitudinal dataset 2005–2012. Statistical Analysis Linear regression models were utilized to examine changes in the energy, saturated fat, and sugar density of RTE GBD products manufactured in each year between 2005 and 2012. Random effects models controlling for demographics, household composition/size, and geographic location were utilized to examine changes in household purchases of RTE GBD products (grams) and the average energy, saturated fat, and sugar density of RTE GBD products purchased. Results The saturated fat density (g/100 g) of RTE GBD products increased significantly from 6.5 ± 0.2 in 2005 to 7.3 ± 0.2 and 7.9 ± 0.2 for pre-existing and newly introduced products in 2012, respectively. Between 2005 and 2012, the energy density (kcal/100 g) of RTE GBD products purchased decreased significantly from 433 ± 0.2 to 422 ± 0.2, the saturated fat density (g/100 g) of products purchased increased significantly from 6.3 ± 0.01 to 6.6 ± 0.01, the sugar density (g/100 g) of products purchased decreased significantly from 32.4 ± 0.03 to 31.3 ± 0.02, and household purchases of RTE GBD products (grams) decreased by 24.1 ± 0.4%. Conclusions These results highlight an opportunity for both food manufacturers and public health officials to develop new strategies to shift consumer purchases towards products with lower energy, saturated fat, and sugar densities in addition to decreasing overall purchases of RTE GBDs. PMID:25541065

75 FR 29303 - Notice of Request for Extension of a Currently Approved Information Collection

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-25

... distributors register their nutritious, value-added foods for institutional food service professionals to... nutritious, value-added foods purchased by the Federal Government. Institutional food service professionals... institutional food service professionals assists processors, distributors, and brokers to view meal-serving...

Hydrogen and oxygen stable isotope ratios of milk in the United States.

PubMed

Chesson, Lesley A; Valenzuela, Luciano O; O'Grady, Shannon P; Cerling, Thure E; Ehleringer, James R

2010-02-24

Models of hydrogen and oxygen incorporation in human tissues recognize the impact of geographic location on the isotopic composition of fluid intake, but inputs can include nonlocal beverages, such as milk. Milk and cow drinking water were collected from dairies, and commercially available milk was purchased from supermarkets and fast food restaurants. It was hypothesized that milk water delta(2)H and delta(18)O values record geographic location information. Correlations between milk water isotope ratios and purchase location tap water were significant. However, the amount of variation in milk delta(2)H and delta(18)O values explained by tap water was low, suggesting a single estimation of fluid input isotope ratios may not always be adequate in studies. The delta(2)H and delta(18)O values of paired milk and cow drinking water were related, suggesting potential for geographical origin assignment using stable isotope analysis. As an application example, milk water delta(18)O values were used to predict possible regions of origin for restaurant samples.

The value prescription: relative value theorem as a call to action.

PubMed

Alston, Greg L; Blizzard, Joseph C

2012-01-01

The Joint Commission of Pharmacy Practitioners Future Vision of Pharmacy Practice 2015 (2005) and Project Destiny (2008) clearly defined a vision for transforming community practice pharmacy from a culture of dispensing drugs to the provision of services. Several viable service offerings were identified. Pharmacy has not yet fully capitalized on these opportunities. Pharmacy must demonstrate value in providing these services to remain viable in the marketplace. Many pharmacists do not understand how value is created and lack sufficient marketing skills to position their practice for long-term success. The relative value theorem (RVT) describes in simple terms the key elements that drive purchase decisions and thus marketing decisions: (P+S)×PV=RV (P, price; S, service; PV, perceived value; RV, relative value). A consumer compares the P, extra S, and PV of the purchase against all potential uses of their scarce resources before deciding what to buy. Evidence suggests that understanding and applying the principles of RVT is a critical skill for pharmacy professionals in all practice settings to master if they plan to remain viable players in the health care marketplace of the future. Copyright © 2012 Elsevier Inc. All rights reserved.

12 CFR 611.1280 - Dissenting stockholders' rights.

Code of Federal Regulations, 2012 CFR

2012-01-01

... least par or face value for eligible borrower stock (as defined in section 4.9A(d)(2) of the Act). If we... follows: (1) Pay cash for the par or face value of purchased stock, less any impairment; (2) For equities... whether it will require stockholders to be borrowers. (2) A description of the current book and par value...

12 CFR 611.1280 - Dissenting stockholders' rights.

Code of Federal Regulations, 2013 CFR

2013-01-01

... least par or face value for eligible borrower stock (as defined in section 4.9A(d)(2) of the Act). If we... follows: (1) Pay cash for the par or face value of purchased stock, less any impairment; (2) For equities... whether it will require stockholders to be borrowers. (2) A description of the current book and par value...

12 CFR 611.1280 - Dissenting stockholders' rights.

Code of Federal Regulations, 2011 CFR

2011-01-01

... least par or face value for eligible borrower stock (as defined in section 4.9A(d)(2) of the Act). If we... follows: (1) Pay cash for the par or face value of purchased stock, less any impairment; (2) For equities... whether it will require stockholders to be borrowers. (2) A description of the current book and par value...

12 CFR 611.1280 - Dissenting stockholders' rights.

Code of Federal Regulations, 2014 CFR

2014-01-01

... least par or face value for eligible borrower stock (as defined in section 4.9A(d)(2) of the Act). If we... follows: (1) Pay cash for the par or face value of purchased stock, less any impairment; (2) For equities... whether it will require stockholders to be borrowers. (2) A description of the current book and par value...

26 CFR 1.423-2 - Employee stock purchase plan defined.

Code of Federal Regulations, 2010 CFR

2010-04-01

... employee owns stock possessing 5 percent or more of the total combined voting power or value of all classes... granted, owns stock possessing 5 percent or more of the total combined voting power or value of all... the percentage of the total combined voting power or value of all classes of stock of the employer...

Valuing values: A history of wilderness economics

Treesearch

J. M. Bowker; H. K. Cordell; N. C. Poudyal

2014-01-01

Prior to the U.S. Wilderness Act of 1964, economics as a science was hardly considered applicable to the types of human values set forth in this pathbreaking legislation. Economics was largely confined to the purchasing and labor decisions of households and firms as well the functioning of markets and economies. However, around this time, John Krutilla (1967) in his...

17 CFR 210.6A-02 - Special rules applicable to employee stock purchase, savings and similar plans.

Code of Federal Regulations, 2011 CFR

2011-04-01

... note shall so state indicating briefly the principal assumptions on which the plan relied in not making..., showing cost parenthetically. For purposes of this rule, the term value shall mean (1) market value for those securities having readily available market quotations and (2) fair value as determined in good...

17 CFR 210.6A-02 - Special rules applicable to employee stock purchase, savings and similar plans.

Code of Federal Regulations, 2010 CFR

2010-04-01

..., INVESTMENT COMPANY ACT OF 1940, INVESTMENT ADVISERS ACT OF 1940, AND ENERGY POLICY AND CONSERVATION ACT OF..., showing cost parenthetically. For purposes of this rule, the term value shall mean (1) market value for those securities having readily available market quotations and (2) fair value as determined in good...

Perception of Organic Food Consumption in Romania.

PubMed

Petrescu, Anca Gabriela; Oncioiu, Ionica; Petrescu, Marius

2017-05-30

This study provides insight into the attitude of Romanian consumers towards organic food. Furthermore, it examines the sustainable food production system in Romania from the perspective of consumer behavior. This study used a mathematical model of linear regression with the main purpose being to determine the best prediction for the dependent variable when given a number of new values for the independent variable. This empirical research is based on a survey with a sample of 672 consumers, which uses a questionnaire to analyze their intentions towards sustainable food products. The results indicate that a more positive attitude of consumers towards organic food products will further strengthen their purchasing intentions, while the status of the consumption of organic consumers will not affect their willingness to purchase organic food products. Statistics have shown that sustainable food consumption is beneficial for health, so it can also become a profitable business in Romania. Furthermore, food sustainability in Romania depends on the ability of an organic food business to adapt to the new requirements of green consumption.

Incentive-compatible guaranteed renewable health insurance premiums.

PubMed

Herring, Bradley; Pauly, Mark V

2006-05-01

Theoretical models of guaranteed renewable insurance display front-loaded premium schedules. Such schedules both cover lifetime total claims of low-risk and high-risk individuals and provide an incentive for those who remain low-risk to continue to purchase the policy. Questions have been raised of whether actual individual insurance markets in the US approximate the behavior predicted by these models, both because young consumers may not be able to "afford" front-loading and because insurers may behave strategically in ways that erode the value of protection against risk reclassification. In this paper, the optimal competitive age-based premium schedule for a benchmark guaranteed renewable health insurance policy is estimated using medical expenditure data. Several factors are shown to reduce the amount of front-loading necessary. Indeed, the resulting optimal premium path increases with age. Actual premium paths exhibited by purchasers of individual insurance are close to the optimal renewable schedule we estimate. Finally, consumer utility associated with the feature is examined.

Provider communication and role modeling related to patients' perceptions and use of a federally qualified health center-based farmers' market.

PubMed

Friedman, Daniela B; Freedman, Darcy A; Choi, Seul Ki; Anadu, Edith C; Brandt, Heather M; Carvalho, Natalia; Hurley, Thomas G; Young, Vicki M; Hébert, James R

2014-03-01

Farmers' markets have the potential to improve the health of underserved communities, shape people's perceptions, values, and behaviors about healthy eating, and serve as a social space for both community members and vendors. This study explored the influence of health care provider communication and role modeling for diabetic patients within the context of a farmers' market located at a federally qualified health center. Although provider communication about diet decreased over time, communication strategies included: providing patients with "prescriptions" and vouchers for market purchases; educating patients about diet; and modeling healthy purchases. Data from patient interviews and provider surveys revealed that patients enjoyed social aspects of the market including interactions with their health care provider, and providers distributed prescriptions and vouchers to patients, shopped at the market, and believed that the market had potential to improve the health of staff and patients of the federally qualified health center. Provider modeling of healthy behaviors may influence patients' food-related perceptions and dietary behaviors.

Exploring the influence of consumer characteristics on veal credence and experience guarantee purchasing motivators.

PubMed

Resano, H; Olaizola, A M; Dominguez-Torreiro, M

2018-07-01

In Europe, in the last decades, public administration has encouraged extensive livestock farming systems, usually related to high quality meat and the preservation of endangered local breeds. Nevertheless, its continuity in the near future should be based on adapting it to the market requirements. This paper investigates consumers' preferences heterogeneity towards veal attributes, as well as the linkage between a wide range of consumer traits and attributes that motivate purchasing of veal with unique characteristics. Main method of analysis included a choice experiment method. Findings showed that regional origin and health information play a stronger role than tenderness degree guarantee at the moment of choice. Moreover, regional origin is more relevant when it is linked to a local breed. Nevertheless, heterogeneous preferences have been detected. In contrast to the general trend, one-person households attach greater importance to the presence of a high degree of tenderness guarantee. Furthermore, younger consumers value more this guarantee, while expert consumers do not. Copyright © 2018 Elsevier Ltd. All rights reserved.

Provider Communication and Role Modeling Related to Patients' Perceptions and Use of a Federally Qualified Health Center-based Farmers' Market

PubMed Central

Friedman, Daniela B.; Freedman, Darcy A.; Choi, Seul Ki; Anadu, Edith C.; Brandt, Heather M.; Carvalho, Natalia; Hurley, Thomas G.; Young, Vicki M.; Hebert, James R.

2013-01-01

Farmers’ markets have the potential to improve the health of underserved communities, shape people’s perceptions, values, and behaviors about healthy eating, and serve as a social space for both community members and vendors. This study explored the influence of health care provider communication and role modeling for diabetic patients within the context of a farmers’ market located at a federally qualified health center (FQHC). Although provider communication about diet decreased over time, communication strategies included: providing patients with “prescriptions” and vouchers for market purchases; educating patients about diet; and modeling healthy purchases. Data from patient interviews and provider surveys revealed that patients enjoyed social aspects of the market including interactions with their health care provider, and providers distributed prescriptions and vouchers to patients, shopped at the market, and believed the market had potential to improve the health of FHQC staff and patients. Provider modeling of healthy behaviors may influence patients’ food-related perceptions and dietary behaviors. PMID:23986503

Benefits of High-Intensity Intensive Care Unit Physician Staffing under the Affordable Care Act

PubMed Central

Logani, Sachin; Green, Adam; Gasperino, James

2011-01-01

The Affordable Care Act signed into law by President Obama, with its value-based purchasing program, is designed to link payment to quality processes and outcomes. Treatment of critically ill patients represents nearly 1% of the gross domestic product and 25% of a typical hospital budget. Data suggest that high-intensity staffing patterns in the intensive care unit (ICU) are associated with cost savings and improved outcomes. We evaluate the literature investigating the cost-effectiveness and clinical outcomes of high-intensity ICU physician staffing as recommended by The Leapfrog Group (a consortium of companies that purchase health care for their employees) and identify ways to overcome barriers to nationwide implementation of these standards. Hospitals that have implemented the Leapfrog initiative have demonstrated reductions in mortality and length of stay and increased cost savings. High-intensity staffing models appear to be an immediate cost-effective way for hospitals to meet the challenges of health care reform. PMID:22110908

Perception of Organic Food Consumption in Romania

PubMed Central

Petrescu, Anca Gabriela; Oncioiu, Ionica; Petrescu, Marius

2017-01-01

This study provides insight into the attitude of Romanian consumers towards organic food. Furthermore, it examines the sustainable food production system in Romania from the perspective of consumer behavior. This study used a mathematical model of linear regression with the main purpose being to determine the best prediction for the dependent variable when given a number of new values for the independent variable. This empirical research is based on a survey with a sample of 672 consumers, which uses a questionnaire to analyze their intentions towards sustainable food products. The results indicate that a more positive attitude of consumers towards organic food products will further strengthen their purchasing intentions, while the status of the consumption of organic consumers will not affect their willingness to purchase organic food products. Statistics have shown that sustainable food consumption is beneficial for health, so it can also become a profitable business in Romania. Furthermore, food sustainability in Romania depends on the ability of an organic food business to adapt to the new requirements of green consumption. PMID:28556795

Opinion survey: materials management and purchasing habits.

PubMed

1988-01-01

This opinion survey was undertaken to gauge the current status of materials management and purchasing departments at hospitals throughout the southern and southeastern United States. The survey was based on lengthy telephone interviews (from 30 to 60 minutes) and followup discussions with materials managers, purchasing agents and administrators. Interviews covered a variety of topics, including: cost-containment strategies; group purchasing and consignment purchasing; and current and anticipated trends in materials management. Many questions were left open-ended, so the survey could gauge attitudes, as well as determine contemporary practices and procedures. (In some cases, respondents were also given the opportunity to comment on the statements of their peers, in order to corroborate and substantiate data.)

Value of oak woodlands and open space on private property values in southern California

Treesearch

Richard B. Standiford; Thomas Scott

2002-01-01

Rapid urbanization of California's oak woodlands is having a pronounced effect on its ecological values. These areas are sought out for new residential sites to a large degree because of their amenity values. In response to this rapid exurban migration, there has been an increase in use of conservation easements and purchase of development rights by land trusts...

A Community-Based Marketing Campaign at Farmers Markets to Encourage Fruit and Vegetable Purchases in Rural Counties With High Rates of Obesity, Kentucky, 2015-2016.

PubMed

DeWitt, Emily; McGladrey, Margaret; Liu, Emily; Peritore, Nicole; Webber, Kelly; Butterworth, Brooke; Vail, Ann; Gustafson, Alison

2017-08-31

Availability of farmers markets may increase fruit and vegetable consumption among rural residents of the United States. We conducted a community-based marketing campaign, Plate it Up Kentucky Proud (PIUKP), in 6 rural communities over 2 years to determine the association between exposure to the campaign and fruit and vegetable purchases, adjusted for Supplemental Nutrition Assistance Program recipient status. Logistic regression was used to examine the odds of the PIUKP campaign influencing purchases. Awareness of the PIUKP marketing campaign was significantly associated with a willingness to prepare fruits and vegetables at home. Using marketing strategies at farmers markets may be an effective way to improve fruit and vegetable purchases in rural communities.

Fuzzy Constraint Based Model for Efficient Management of Dynamic Purchasing Environments

NASA Astrophysics Data System (ADS)

Sakas, D. P.; Vlachos, D. S.; Simos, T. E.

2007-12-01

This paper considers the application of a fuzzy constraint based model for handling dynamic environments where only one of possibly many bundles of items must be purchased and quotes for items open and close over time. Simulation results are presented and compared with the optimal solution.

In Mexico, Evidence Of Sustained Consumer Response Two Years After Implementing A Sugar-Sweetened Beverage Tax.

PubMed

Colchero, M Arantxa; Rivera-Dommarco, Juan; Popkin, Barry M; Ng, Shu Wen

2017-03-01

Mexico implemented a 1 peso per liter excise tax on sugar-sweetened beverages on January 1, 2014, and a previous study found a 6 percent reduction in purchases of taxed beverages in 2014. In this study we estimated changes in beverage purchases for 2014 and 2015. We used store purchase data for 6,645 households from January 2012 to December 2015. Changes in purchases of taxed and untaxed beverages in the study period were estimated using two models, which compared 2014 and 2015 purchases with predicted (counterfactual) purchases based on trends in 2012-13. Purchases of taxed beverages decreased 5.5 percent in 2014 and 9.7 percent in 2015, yielding an average reduction of 7.6 percent over the study period. Households at the lowest socioeconomic level had the largest decreases in purchases of taxed beverages in both years. Purchases of untaxed beverage increased 2.1 percent in the study period. Findings from Mexico may encourage other countries to use fiscal policies to reduce consumption of unhealthy beverages along with other interventions to reduce the burden of chronic disease. Project HOPE—The People-to-People Health Foundation, Inc.

Pricing effects on food choices.

PubMed

French, Simone A

2003-03-01

Individual dietary choices are primarily influenced by such considerations as taste, cost, convenience and nutritional value of foods. The current obesity epidemic has been linked to excessive consumption of added sugars and fat, as well as to sedentary lifestyles. Fat and sugar provide dietary energy at very low cost. Food pricing and marketing practices are therefore an essential component of the eating environment. Recent studies have applied economic theories to changing dietary behavior. Price reduction strategies promote the choice of targeted foods by lowering their cost relative to alternative food choices. Two community-based intervention studies used price reductions to promote the increased purchase of targeted foods. The first study examined lower prices and point-of-purchase promotion on sales of lower fat vending machine snacks in 12 work sites and 12 secondary schools. Price reductions of 10%, 25% and 50% on lower fat snacks resulted in an increase in sales of 9%, 39% and 93%, respectively, compared with usual price conditions. The second study examined the impact of a 50% price reduction on fresh fruit and baby carrots in two secondary school cafeterias. Compared with usual price conditions, price reductions resulted in a four-fold increase in fresh fruit sales and a two-fold increase in baby carrot sales. Both studies demonstrate that price reductions are an effective strategy to increase the purchase of more healthful foods in community-based settings such as work sites and schools. Results were generalizable across various food types and populations. Reducing prices on healthful foods is a public health strategy that should be implemented through policy initiatives and industry collaborations.

A Critical Analysis of Purchasing Arrangements in Kenya: The Case of the National Hospital Insurance Fund

PubMed Central

Munge, Kenneth; Mulupi, Stephen; Barasa, Edwine W.; Chuma, Jane

2018-01-01

Background: Purchasing refers to the process by which pooled funds are paid to providers in order to deliver a set of health care interventions. Very little is known about purchasing arrangements in low- and middle-income countries (LMICs), and certainly not in Kenya. This study aimed to critically analyse purchasing arrangements in Kenya, using the National Hospital Insurance Fund (NHIF) as a case study. Methods: We applied a principal-agent relationship framework, which identifies three pairs of principal-agent relationships (government-purchaser, purchaser-provider, and citizen-purchaser) and specific actions required within them to achieve strategic purchasing. A qualitative case study approach was applied. Data were collected through document reviews (statutes, policy and regulatory documents) and in-depth interviews (n=62) with key informants including NHIF officials, Ministry of Health (MoH) officials, insurance industry actors, and health service providers. Documents were summarised using standardised forms. Interviews were recorded, transcribed verbatim, and analysed using a thematic framework approach. Results: The regulatory and policy framework for strategic purchasing in Kenya was weak and there was no clear accountability mechanism between the NHIF and the MoH. Accountability mechanisms within the NHIF have developed over time, but these emphasized financial performance over other aspects of purchasing. The processes for contracting, monitoring, and paying providers do not promote equity, quality, and efficiency. This was partly due to geographical distribution of providers, but also due to limited capacity within the NHIF. There are some mechanisms for assessing needs, preferences, and values to inform design of the benefit package, and while channels to engage beneficiaries exist, they do not always function appropriately and awareness of these channels to the beneficiaries is limited. Conclusion: Addressing the gaps in the NHIF’s purchasing performance requires a number of approaches. Critically, there is a need for the government through the MoH to embrace its stewardship role in health, while recognizing the multiplicity of actors given Kenya’s devolved context. Relatively recent decentralisation reforms present an opportunity that should be grasped to rewrite the contract between the government, the NHIF and Kenyans in the pursuit of universal health coverage (UHC). PMID:29524953

Evaluation of the physico-chemical, rheological and sensory characteristics of commercially available Frankfurters in Spain and consumer preferences.

PubMed

González-Viñas, M A; Caballero, A B; Gallego, I; García Ruiz, A

2004-08-01

The physico-chemical, rheological and sensory characteristics of different commercially available Frankfurters were studied. Samples presented values of A(w) and pH from 0.954 to 0.972 and 5.88 to 6.43, respectively. Greater differences were observed in parameters such as fat and salt content, with values ranging from 10.83% to 21.92% and 1.85% to 3.01%, respectively. With regard to total nitrogen, all samples presented values close to 2%. Free-choice profiling and generalised procrustes analysis of the sensory data permitted differentiation between samples and provided information about the attributes responsible for the observed differences. All the frankfurters scored in the moderate range for overall acceptability. Consumers identified reasons for purchasing frankfurters when evaluating the product's packaging. The most important criterion for consumers when purchasing frankfurters was the appetising aspect of the product in the packaging's illustration.

Where do people purchase food? A novel approach to investigating food purchasing locations.

PubMed

Thornton, Lukar E; Crawford, David A; Lamb, Karen E; Ball, Kylie

2017-03-07

Studies exploring associations between food environments and food purchasing behaviours have been limited by the absence of data on where food purchases occur. Determining where food purchases occur relative to home and how these locations differ by individual, neighbourhood and trip characteristics is an important step to better understanding the association between food environments and food behaviours. Conducted in Melbourne, Australia, this study recruited participants within sixteen neighbourhoods that were selected based on their socioeconomic characteristics and proximity to supermarkets. The survey material contained a short questionnaire on individual and household characteristics and a food purchasing diary. Participants were asked to record details related to all food purchases made over a 2-week period including food store address. Fifty-six participants recorded a total of 952 food purchases of which 893 were considered valid for analysis. Households and food purchase locations were geocoded and the network distance between these calculated. Linear mixed models were used to determine associations between individual, neighbourhood, and trip characteristics and distance to each food purchase location from home. Additional analysis was conducted limiting the outcome to: (a) purchase made when home was the prior origin (n. 484); and (b) purchases made within supermarkets (n. 317). Food purchases occurred a median distance of 3.6 km (IQR 1.8, 7.2) from participants' homes. This distance was similar when home was reported as the origin (median 3.4 km; IQR 1.6, 6.4) whilst it was shorter for purchases made within supermarkets (median 2.8 km; IQR 1.6, 5.6). For all purchases, the reported food purchase location was further from home amongst the youngest age group (compared to the oldest age group), when workplace was the origin of the food purchase trip (compared to home), and on weekends (compared to weekdays). Differences were also observed by neighbourhood characteristics. This study has demonstrated that many food purchases occur outside what is traditionally considered the residential neighbourhood food environment. To better understand the role of food environments on food purchasing behaviours, further work is needed to develop more appropriate food environment exposure measures.

Experimental analysis of the effect of taxes and subsides on calories purchased in an on-line supermarket.

PubMed

Epstein, Leonard H; Finkelstein, Eric; Raynor, Hollie; Nederkoorn, Chantal; Fletcher, Kelly D; Jankowiak, Noelle; Paluch, Rocco A

2015-12-01

Taxes and subsidies are a public health approach to improving nutrient quality of food purchases. While taxes or subsidies influence purchasing, it is unclear whether they influence total energy or overall diet quality of foods purchased. Using a within subjects design, selected low nutrient dense foods (e.g. sweetened beverages, candy, salty snacks) were taxed, and fruits and vegetables and bottled water were subsidized by 12.5% or 25% in comparison to a usual price condition for 199 female shoppers in an experimental store. Results showed taxes reduced calories purchased of taxed foods (coefficient = -6.61, CI = -11.94 to -1.28) and subsidies increased calories purchased of subsidized foods (coefficient = 13.74, CI = 8.51 to 18.97). However, no overall effect was observed on total calories purchased. Both taxes and subsidies were associated with a reduction in calories purchased for grains (taxes: coefficient = -6.58, CI = -11.91 to -1.24, subsidies: coefficient = -12.86, CI = -18.08 to -7.63) and subsidies were associated with a reduction in calories purchased for miscellaneous foods (coefficient = -7.40, CI = -12.62 to -2.17) (mostly fats, oils and sugars). Subsidies improved the nutrient quality of foods purchased (coefficient = 0.14, CI = 0.07 to 0.21). These results suggest that taxes and subsidies can influence energy purchased for products taxed or subsidized, but not total energy purchased. However, the improvement in nutrient quality with subsidies indicates that pricing can shift nutritional quality of foods purchased. Research is needed to evaluate if differential pricing strategies based on nutrient quality are associated with reduction in calories and improvement in nutrient quality of foods purchased. Copyright © 2015 Elsevier Ltd. All rights reserved.

Introducing taxes, subsidies or both: the effects of various food pricing strategies in a web-based supermarket randomized trial.

PubMed

Waterlander, Wilma E; Steenhuis, Ingrid H M; de Boer, Michiel R; Schuit, Albertine J; Seidell, Jacob C

2012-05-01

Fiscal policies may form a solution in improving dietary intake. This study aimed to examine the effectiveness of varying taxing and subsiding schemes to stimulate healthier food purchases. A randomized controlled trial with three levels of price reduction on healthy foods (no; 25%; 50%)×three levels of price increase on unhealthy foods (5%; 10%; 25%) factorial design was used. 150 participants were randomized into one of nine conditions and were asked to purchase groceries at a web-based supermarket. Data were collected in the Netherlands in January-February 2010 and analyzed using analysis of covariance. Subjects receiving 50% discount purchased significantly more healthy foods than subjects receiving no (mean difference=6.62 items, p<0.01) or 25% discount (mean difference=4.87 items, p<0.05). Moreover, these subjects purchased more vegetables (mean difference=821 g;p<0.05 compared to no discount). However, participants with the highest discount also purchased significantly more calories. No significant effects of the price increases on unhealthy foods were found. Price decreases are effective in stimulating healthy food purchases, but the proportion of healthy foods remains unaffected. Price increases up to 25% on unhealthier products do not significantly affect food purchases. Future studies are important to validate these results in real supermarkets and across different countries. Copyright © 2012 Elsevier Inc. All rights reserved.

Nonstandard Logistics Success in Unconventional Warfare

DTIC Science & Technology

2015-11-01

water from local farms , vendors, and markets. The PACE plan would be con- stantly updated as the operational picture changes, such as a variation in...sus- tainability. For example, if a forward element is purchasing a noticeable amount of rice from a local farm , the team might begin purchasing rice...another OE be forced to use another item that has value. Cash may work in a city center, but a goat in a rural area is just as valuable and easily sold

Supply Chain Management: Are You Maximizing Your Procurement Activity?

ERIC Educational Resources Information Center

Dobbin, James; Jenkins, Mike

2000-01-01

Today's purchasing professionals recognize the need to reduce non-value-added procedures (clerical functions) while emphasizing strategic planning. Results-oriented supply-chain managers need superb communication, negotiation, and leadership skills to achieve long-term value and resist the lowest, first- cost bids. (Contains 13 references.) (MLH)

Sustained consumer response: evidence from two-years after implementing the sugar sweetened beverage tax in Mexico

PubMed Central

Colchero, M. Arantxa; Rivera, Juan A.; Popkin, Barry M.

2017-01-01

In the first year of a 1 peso per liter excise tax on sugar-sweetened beverages, there was a 6% reduction in purchases of taxed beverages in Mexico. This paper estimates changes in beverage purchases two years after tax implementation. We used household store purchase data for 6,645 households from January 2012 to December 2015. Changes in purchases of taxed and untaxed beverages in the post-tax years were estimated using two separate models: comparing 2014 with predicted volumes (counterfactual) based on pre-tax (2012-2013) trends, and comparing 2015 with the same counterfactual. Purchases of taxed beverages decreased by 8.2% over the two years on average (-5.5% in 2014; -9.7% in 2015). The lowest socioeconomic group had the largest decreases in taxed beverages in both years. Untaxed beverage purchases increased 2.1% in the post-tax period. In Mexico, lower purchases of taxed beverages was sustained and grew in the second year of the tax. PMID:28228484

Shopping for health: purchasing health services through contracts.

PubMed

Howden-Chapman, P; Ashton, T

1994-01-01

The 1993 New Zealand health service reforms were based on the purported efficiencies of the purchaser/provider split. Purchasers are required to contract for services that will maintain, improve and restore the health of the populations they serve. The purchasing role, which requires the development of contracting skills as well as the setting of strategic directions and priorities, is new and as yet poorly developed. This paper describes the role of purchasing agents in setting priorities, the different approaches that are being taken to contracting for services and some of the problems that have arisen in the first year of contracting. It explores the trade-off that is evident between the potential for improving efficiency through contestable contracting and the need to minimise transaction costs associated with the contracting process. The purchasers' accountability to the public and the Minister is analysed in the broader political context of the purchasers' role in shaping a public health service and improving the health of the population.

A Strategic Framework for Improving the Patient Experience in Hospitals.

PubMed

Birkelien, Natalie L

Hospitals are taking new approaches to satisfy consumers and deliver on customer expectations by enhancing their patients' comprehensive experience. The HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey and value-based purchasing initiatives have tied reimbursement to patient satisfaction scores, bringing patient perspectives on care to the forefront of hospitals' strategic priorities. This essay reviews the patient experience literature and argues that hospitals should adopt an expanded approach beyond HCAHPS measures to enhance the patient experience. Such an approach allows providers to deliver quality outcomes that satisfy patients' wants and needs.

Biocidal treatment and preservation of liquid fuels

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

Siegert, W.

1995-05-01

Strict microbiological limit values are the result of damage caused by microorganisms in fuels. With MAR 71, a biocide based on methylenebisoxazolidine, a product is available which has been tested and approved by leading car manufacturers, the mineral oil industry, and NATO. Depending on the degree of microbiological contamination, different decontamination concepts are presented, and recommendations for the treatment of fuels which are contaminated when purchased are given. In order to avoid recontamination, planning principles or the new design of tanks are necessary. The possibility of convenient, economical and regular drainage is a key factor.

Achieving universal health coverage goals in Thailand: the vital role of strategic purchasing.

PubMed

Tangcharoensathien, Viroj; Limwattananon, Supon; Patcharanarumol, Walaiporn; Thammatacharee, Jadej; Jongudomsuk, Pongpisut; Sirilak, Supakit

2015-11-01

Strategic purchasing is one of the key policy instruments to achieve the universal health coverage (UHC) goals of improved and equitable access and financial risk protection. Given favourable outcomes of Universal Coverage Scheme (UCS), this study synthesized strategic purchasing experiences in the National Health Security Office (NHSO) responsible for the UCS in contributing to achieving UHC goals. The UCS applied the purchaser-provider split concept where NHSO, as a purchaser, is in a good position to enforce accountability by public and private providers to the UCS beneficiaries, through active purchasing. A comprehensive benefit package resulted in high level of financial risk protection as reflected by low incidence of catastrophic health spending and impoverished households. The NHSO contracted the District Health System (DHS) network, to provide outpatient, health promotion and disease prevention services to the whole district population, based on an annual age-adjusted capitation payment. In most cases, the DHS was the only provider in a district without competitors. Geographical monopoly hampered the NHSO to introduce a competitive contractual agreement, but a durable, mutually dependent relationship based on trust was gradually evolved, while accreditation is an important channel for quality improvement. Strategic purchasing services from DHS achieved a pro-poor utilization due to geographical proximity, where travel time and costs were minimal. Inpatient services paid by Diagnostic Related Group within a global budget ceiling, which is estimated based on unit costs, admission rates and admission profiles, contained cost effectively. To prevent potential under-provisions of the services, some high cost interventions were unbundled from closed end payment and paid on an agreed fee schedule. Executing monopsonistic purchasing power by NHSO brought down price of services given assured quality. Cost saving resulted in more patients served within a finite annual budget. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014.

Intervention impact on depression product appraisal and purchasing behavior by employers: a randomized trial.

PubMed

Rost, Kathryn M; Marshall, Donna; Xu, Stanley

2014-09-24

Employers can purchase high quality depression products that provide the type, intensity and duration of depression care management shown to improve work outcomes sufficiently for many employers to achieve a return on investment. The purpose of this randomized controlled trial was to test an intervention to encourage employers to purchase a high quality depression product for their workforce. Twenty nine organizations recruited senior health benefit professional members representing public or private employers who had not yet purchased a depression product for all 100+ workers in their company. The research team used randomization blocked by company size to assign eligible employers to: (1) a presentation encouraging employers to purchase a high quality depression product accompanied by a scientifically-derived return on investment estimate, or (2) a presentation encouraging employers to work with their most subscribed health plan to improve depression treatment quality indicators. Two hundred ninety three employers (82.3% of 356) completed baseline data immediately before learning that 140 employers had been randomized to the evidence-based (EB) depression product presentation and 153 had been randomized to the usual care (UC) depression treatment quality indicator presentation. Analysis of 250 (85.3% of 293) employers who completed web-based interviews at 12 and/or 24 months was conducted to determine presentation impact on depression product appraisal and purchasing behavior. The intervention had no impact on depression product appraisal in 232 subjects (F = 2.36, p = .07) or depression product purchasing (chisquare = 1.82, p = .44) in 250 subjects. Depression product appraisal increased in companies with greater health benefit generosity whose benefit professionals were male. Depression product purchasing behavior increased in small companies compared to large companies, companies who knew a vendor that sold depression products at baseline, companies with greater health benefit risk taking, and companies with less politicalization of health care benefit decision making. Policy makers need to build innovative bridges to the employer community to convince them to purchase evidence-based benefits, even when benefits offer potential financial savings. NCT01013220.

Achieving universal health coverage goals in Thailand: the vital role of strategic purchasing

PubMed Central

Tangcharoensathien, Viroj; Limwattananon, Supon; Patcharanarumol, Walaiporn; Thammatacharee, Jadej; Jongudomsuk, Pongpisut; Sirilak, Supakit

2015-01-01

Strategic purchasing is one of the key policy instruments to achieve the universal health coverage (UHC) goals of improved and equitable access and financial risk protection. Given favourable outcomes of Universal Coverage Scheme (UCS), this study synthesized strategic purchasing experiences in the National Health Security Office (NHSO) responsible for the UCS in contributing to achieving UHC goals. The UCS applied the purchaser–provider split concept where NHSO, as a purchaser, is in a good position to enforce accountability by public and private providers to the UCS beneficiaries, through active purchasing. A comprehensive benefit package resulted in high level of financial risk protection as reflected by low incidence of catastrophic health spending and impoverished households. The NHSO contracted the District Health System (DHS) network, to provide outpatient, health promotion and disease prevention services to the whole district population, based on an annual age-adjusted capitation payment. In most cases, the DHS was the only provider in a district without competitors. Geographical monopoly hampered the NHSO to introduce a competitive contractual agreement, but a durable, mutually dependent relationship based on trust was gradually evolved, while accreditation is an important channel for quality improvement. Strategic purchasing services from DHS achieved a pro-poor utilization due to geographical proximity, where travel time and costs were minimal. Inpatient services paid by Diagnostic Related Group within a global budget ceiling, which is estimated based on unit costs, admission rates and admission profiles, contained cost effectively. To prevent potential under-provisions of the services, some high cost interventions were unbundled from closed end payment and paid on an agreed fee schedule. Executing monopsonistic purchasing power by NHSO brought down price of services given assured quality. Cost saving resulted in more patients served within a finite annual budget. PMID:25378527

Defining the value of magnetic resonance imaging in prostate brachytherapy using time-driven activity-based costing.

PubMed

Thaker, Nikhil G; Orio, Peter F; Potters, Louis

Magnetic resonance imaging (MRI) simulation and planning for prostate brachytherapy (PBT) may deliver potential clinical benefits but at an unknown cost to the provider and healthcare system. Time-driven activity-based costing (TDABC) is an innovative bottom-up costing tool in healthcare that can be used to measure the actual consumption of resources required over the full cycle of care. TDABC analysis was conducted to compare patient-level costs for an MRI-based versus traditional PBT workflow. TDABC cost was only 1% higher for the MRI-based workflow, and utilization of MRI allowed for cost shifting from other imaging modalities, such as CT and ultrasound, to MRI during the PBT process. Future initiatives will be required to follow the costs of care over longer periods of time to determine if improvements in outcomes and toxicities with an MRI-based approach lead to lower resource utilization and spending over the long-term. Understanding provider costs will become important as healthcare reform transitions to value-based purchasing and other alternative payment models. Copyright © 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

Quality improvement and cost reduction realized by a purchaser through diabetes disease management.

PubMed

Snyder, James W; Malaskovitz, Joyce; Griego, Janet; Persson, Jeffrey; Flatt, Kristy

2003-01-01

This report documents the clinical improvements and costs experienced by a purchaser after introduction of a diabetes disease management program. A purchaser contracted with American Healthways, a disease management organization, to initiate a diabetes disease management program called Diabetes Decisions. Started in 1998, the program grew to include 662 participants. The results reported are based on the continuously participating population (12 months of participation in the program for the reporting year). Participants were entered into American Healthways' clinical information system and risk-stratified, and an individualized treatment plan was devised. Outbound telephone calls by specially trained nurses were a key intervention. Data were collected on key process measures, financial parameters, and participant satisfaction. By year 3, there were 422 continuously participating participants. From baseline to the third year of the program, significant increases in frequency of A1C testing (21.3% to 82.2%), dilated retinal exams (17.2% to 70.7%), and performance of foot exams (2.0% to 75.6%) were noted. For 166 participants with five A1C determinations, A1C values dropped from 8.89% to 7.88%. Participants experienced a 36% drop in inpatient costs. Without adjustment for medical inflation, total medical costs decreased by 26.8% from the baseline period, dropping to $268.63 per diabetes participant per month (PDPPM) by year 3, a gross savings of $98.49 PDPPM. After subtracting the fees paid to Diabetes Decisions, a net savings of $986,538 was realized. This yielded a return on investment of 3.37. By investing in a diabetes disease management program, a purchaser was able to realize significant improvements in clinical care, substantial cost savings, and a favorable return on investment.

Parents' level of support for adults' purchase and consumption of alcohol at primary school events when children are present.

PubMed

Ward, Bernadette; Kippen, Rebecca; Buykx, Penny; Gilligan, Conor; Chapman, Kathy

2015-03-01

Environmental and societal factors are significant determinants of children's initiation to and use of alcohol. Schools are important settings for promoting well-being and substantial resources have been devoted to curriculum-based alcohol programs, but the effects of these in reducing the misuse of alcohol have been modest. Adults can and do consume alcohol at school events when students are present, but there is a dearth of evidence about parents' level of support for the practice. The aim of this study was to examine parents' level of support for the purchase and consumption of alcohol at primary school fundraising events when children are present. Four hundred seventy-nine Australian parents of children aged 0-12 years participated in an online survey. Logistic regression was used to assess the impact of parent characteristics on the level of agreement with parental purchase and consumption of alcohol at school fundraising events when children are present. The majority of parents (60%) disagreed/strongly disagreed with the practice of adults being able to purchase and consume alcohol at school fundraising events when children were present. The 21% of parents who supported the practice were more likely to be daily smokers and/or have higher (>6) Alcohol Use Disorders Identification Test-alcohol consumption scores. Despite the fact that the majority of parents disagree with this practice, published reports suggest that adults' use of alcohol at primary school events is an emerging issue. It is important that school decision-makers are mindful of the financial and educational value of fundraising activities. © 2014 Australasian Professional Society on Alcohol and other Drugs.

78 FR 13549 - Special Supplemental Nutrition Program for Women, Infants and Children (WIC): Implementation of...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-28

... FI must usually be purchased in totality. In addition, FIs do not yield data on the type, amount, and... amend Sec. 246.2 to add the definition of EBT. Cash-Value Voucher/Cash-Value Benefit. Federal WIC regulations (Sec. 246.2) provide definitions for cash-value vouchers (CVV) and food instruments, and within...

User Values in the Selection of Information Services. Final Report.

ERIC Educational Resources Information Center

Hall, Homer J.

The value systems by which the users of purchased information services select which one to use or buy are found to differ sharply among different user populations, but the variable found to control them is a function of use, not of the user as an individual. Selection variables are summarized in a matrix of user values and interaction effects. The…

Snack purchasing is healthier when the cognitive demands of choice are reduced: A randomized controlled trial.

PubMed

Allan, Julia L; Johnston, Marie; Campbell, Neil

2015-07-01

Individuals with inefficient executive (higher level cognitive) function have a reduced ability to resist dietary temptation. The present study aimed to design and test a theory-based point-of-purchase intervention for coffee shops that reduced the calorie content of customers' purchases by reducing the need for executive function (EF) at the moment of choice. Key facets of EF were identified by a multidisciplinary group and used to develop a point-of-purchase intervention (signage). This intervention was evaluated in a randomized controlled trial (RCT) in a public coffee shop on consumer purchases of >20,000 snacks and drinks over 12 weeks. A sample of customers (n = 128) was recruited to complete an embedded cross-sectional study measuring EF strength, dietary intentions, typical purchases, and purchases made after exposure to the intervention. The proportion of snack purchases that were high in calorie reduced significantly (t(10) = 2.34, p = .04) in intervention weeks relative to control. High calorie drink purchases were also lower in intervention than control weeks, however, this difference was not significant (t(10) = 1.56, p = .15). On average, customers purchased items containing 66 calories < usual after exposure to the intervention. The magnitude of the intervention's positive effect on customer behavior increased as EF strength decreased (β = .24, p = .03). The calorie content of cafe purchases can be lowered by reducing the cognitive demands of healthy food choice at the moment of purchase, especially in those with poor EF. Environmental changes like these have the potential to help achieve population weight control. (c) 2015 APA, all rights reserved.

Purchase habits, use of paracetamol, and information sources on a reregulated Swedish pharmacy market: A population-based study.

PubMed

Hedenrud, T; Håkonsen, H

2017-01-01

Considering the general lack of knowledge on how over-the-counter paracetamol is used combined with the reported increase in paracetamol poisonings after the reregulation of the Swedish pharmacy market in 2009, we aimed to analyze purchase habits and use of paracetamol in Sweden. A further aim was to investigate sources of information about paracetamol. Data were collected in October 2015 through the Citizen Panel, a Web-based panel encompassing over 50,000 Swedes. A stratified sample of 6000 (aged 18 years and older) was emailed a survey invitation. Questions concerned paracetamol use, purchase habits and information sources. The participation rate was 58%. A majority (70.5%) reported use of paracetamol during the last three months. Purchasing paracetamol solely over-the-counter was most common (81.1%). Close to two-thirds usually purchased paracetamol at a pharmacy. However, it was more common to purchase OTC paracetamol at non-pharmacy outlets among younger compared to older respondents. The results of this study did not reveal any harmful paracetamol use. The most common information source overall was patient information leaflets, and it was significantly more common among the youngest compared to older subjects. Based on our results combined with previous research, we suggest more studies, both qualitative and quantitative, among young adults, both on the use of paracetamol and on the understanding of information in patient information leaflets and on the Internet. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Naturalistic assessment of demand for cigarettes, snus, and nicotine gum.

PubMed

Stein, Jeffrey S; Wilson, A George; Koffarnus, Mikhail N; Judd, Michael C; Bickel, Warren K

2017-01-01

Behavioral economic measures of demand provide estimates of tobacco product abuse liability and may predict effects of policy-related price regulation on consumption of existing and emerging tobacco products. In the present study, we examined demand for snus, a smokeless tobacco product, in comparison to both cigarettes and medicinal nicotine. We used both a naturalistic method in which participants purchased these products for use outside the laboratory, as well as laboratory-based self-administration procedures. Cigarette smokers (N = 42) used an experimental income to purchase their usual brand of cigarettes and either snus or gum (only one product available per session) across a range of prices, while receiving all products they purchased from one randomly selected price. In a separate portion of the study, participants self-administered these products during laboratory-based, progressive ratio sessions. Demand elasticity (sensitivity of purchasing to price) was significantly greater for snus than cigarettes. Elasticity for gum was intermediate between snus and cigarettes but was not significantly different than either. Demand intensity (purchasing unconstrained by price) was significantly lower for gum compared to cigarettes, with no significant difference observed between snus and cigarettes. Results of the laboratory-based, progressive ratio sessions were generally discordant with measures of demand elasticity, with significantly higher "breakpoints" for cigarettes compared to gum and no significant differences between other study products. Moreover, breakpoints and product purchasing were generally uncorrelated across tasks. Under naturalistic conditions, snus appears more sensitive to price manipulation than either cigarettes or nicotine gum in existing smokers.

46 CFR 287.9 - Valuation of securities in fund.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION REGULATIONS AFFECTING SUBSIDIZED VESSELS AND... values. In cases where securities are deposited in the fund in lieu of cash, or are purchased with cash on deposit in the fund, or are substituted for securities in the fund, the value of such securities...

77 FR 43723 - Energy Efficiency and Conservation Loan Program

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-26

... communities by investing in energy efficiency, and (5) encouraging the use of renewable energy fuels for both... contracts. Impacts The new Subpart H. for the Energy Efficiency and Conservation Loan Program can have several economic impacts. The benefits include: (1) The value of purchased energy saved; (2) the value of...

19 CFR 141.85 - Pro forma invoice.

Code of Federal Regulations, 2011 CFR

2011-04-01

... purchased by me. The prices, or in the case of consigned goods the values, given below are true and correct... paid or agreed to be paid (_) as per order dated ______. (b) Advices from exporter by letter (—) by... States (if U.S. Value) (_) ______. (f) Advices of the Port Director (_) ______. (g) Other (_) ______. A...

14 CFR 399.43 - Treatment of leased aircraft.

Code of Federal Regulations, 2010 CFR

2010-01-01

... leased aircraft value (determined on a constructive depreciated basis) in relation to net book value of... aircraft, to the extent that such risks are not compensated by the return on investment. Such profit... exceeding depreciation plus return on investment computed as if the aircraft had been purchased by the...

Who purchases nonprescription syringes? Characterizing customers of the Expanded Syringe Access Program (ESAP).

PubMed

Battles, Haven B; Rowe, Kirsten A; Ortega-Peluso, Christina; Klein, Susan J; Tesoriero, James M

2009-11-01

This study represents the first attempt in the USA to survey pharmacy nonprescription syringe customers at their point of purchase. We surveyed 62 individuals purchasing nonprescription syringes in seven pharmacies located in NYC and Albany, NY, USA. Three quarters of respondents purchased for illicit use, and 36% purchased for medical use, with differences found by race and gender. Half got their syringes from pharmacies "most of the time." Half had ever been refused a syringe purchase in a NYS pharmacy, with men, Blacks, and Hispanics reporting higher levels of refusals than women or whites. Two thirds reported syringe reuse but very few reported sharing. While approximately one quarter safely obtained and disposed of syringes "most of the time," two thirds used both safe and unsafe methods. Pharmacy-based syringe access programs are essential in areas not served by syringe exchanges.

The Research on the Factors of Purchase Intention for Fresh Agricultural Products in an E-Commerce Environment

NASA Astrophysics Data System (ADS)

Han, Dan; Mu, Jing

2017-12-01

Based on the characteristics of e-commerce of fresh agricultural products in China, and using the correlation analysis method, the relational model between product knowledge, perceived benefit, perceived risk and purchase intention is constructed. The Logistic model is used to carry in the empirical analysis. The influence factors and the mechanism of online purchase intention are explored. The results show that consumers’ product knowledge, perceived benefit and perceived risk can affect their purchase intention. Consumers’ product knowledge has a positive effect on perceived benefit and perceived benefit has a positive effect on purchase intention. Consumers’ product knowledge has a negative effect on perceived risk, and perceived profit has a negative effect on perceived risk, and perceived risk has a negative effect on purchase intention. Through the empirical analysis, some feasible suggestions for the government and electricity supplier enterprises can be provided.

Do green products make us better people?

PubMed

Mazar, Nina; Zhong, Chen-Bo

2010-04-01

Consumer choices reflect not only price and quality preferences but also social and moral values, as witnessed in the remarkable growth of the global market for organic and environmentally friendly products. Building on recent research on behavioral priming and moral regulation, we found that mere exposure to green products and the purchase of such products lead to markedly different behavioral consequences. In line with the halo associated with green consumerism, results showed that people act more altruistically after mere exposure to green products than after mere exposure to conventional products. However, people act less altruistically and are more likely to cheat and steal after purchasing green products than after purchasing conventional products. Together, our studies show that consumption is connected to social and ethical behaviors more broadly across domains than previously thought.

Impact of a Rewards-Based Incentive Program on Promoting Fruit and Vegetable Purchases

PubMed Central

Phipps, Etienne J.; Braitman, Leonard E.; Stites, Shana D.; Singletary, S. Brook; Wallace, Samantha L.; Hunt, Lacy; Axelrod, Saul; Glanz, Karen; Uplinger, Nadine

2015-01-01

Objectives. We assessed the impact of a rewards-based incentive program on fruit and vegetable purchases by low-income families. Methods. We conducted a 4-phase prospective cohort study with randomized intervention and wait-listed control groups in Philadelphia, Pennsylvania, in December 2010 through October 2011. The intervention provided a rebate of 50% of the dollar amount spent on fresh or frozen fruit and vegetables, reduced to 25% during a tapering phase, then eliminated. Primary outcome measures were number of servings of fruit and of vegetables purchased per week. Results. Households assigned to the intervention purchased an average of 8 (95% confidence interval [CI] = 1.5, 16.9) more servings of vegetables and 2.5 (95% CI = 0.3, 9.5) more servings of fruit per week than did control households. In longitudinal price-adjusted analyses, when the incentive was reduced and then discontinued, the amounts purchased were similar to baseline. Conclusions. Investigation of the financial costs and potential benefits of incentive programs to supermarkets, government agencies, and other stakeholders is needed to identify sustainable interventions. PMID:24625144

Gains Made By Walmart's Healthier Food Initiative Mirror Preexisting Trends.

PubMed

Taillie, Lindsey Smith; Ng, Shu Wen; Popkin, Barry M

2015-11-01

Healthier food initiatives conducted by national food retailers may offer opportunities to improve the nutritional profile of food purchases. Using a longitudinal data set of packaged food purchases made by US households, we examined the effect of a healthier food initiative officially launched by Walmart in 2011. From 2000 to 2013, household-level purchases of packaged foods at Walmart showed major declines in energy, sodium, and total sugar density, as well as in quantities of sugary beverages, grain-based desserts, snacks, and candy. These trends in packaged food purchases were more pronounced than similar concurrent trends seen at other major food retailers. However, the declines seen at Walmart after the initiative's official implementation did not exceed what would have been expected had pre-implementation trends continued, and therefore they cannot be attributed to the initiative. These results suggest that food retailer-based initiatives that purportedly create a healthier food environment may not suffice to improve the nutritional profile of food purchases. More systemic shifts in consumers' characteristics and preferences may be needed. Project HOPE—The People-to-People Health Foundation, Inc.

Disinvestment and Value-Based Purchasing Strategies for Pharmaceuticals: An International Review.

PubMed

Parkinson, Bonny; Sermet, Catherine; Clement, Fiona; Crausaz, Steffan; Godman, Brian; Garner, Sarah; Choudhury, Moni; Pearson, Sallie-Anne; Viney, Rosalie; Lopert, Ruth; Elshaug, Adam G

2015-09-01

Pharmaceutical expenditure has increased rapidly across many Organisation for Economic Cooperation and Development (OECD) countries over the past three decades. This growth is an increasing concern for governments and other third-party payers seeking to provide equitable and comprehensive healthcare within sustainable budgets. In order to create headroom for increasing utilisation, and to fund new high-cost therapies, there is an active push to 'disinvest' from low-value drugs. The aim of this article is to review how reimbursement policy decision makers have sought to partially or completely disinvest from drugs in a range of OECD countries (UK, France, Canada, Australia and New Zealand) where they are publicly funded or subsidised. We employed a systematic literature search strategy and the incorporation of grey literature known to the authorship team. We canvass key policy instruments from each country to outline key approaches to the identification of candidate drugs for disinvestment assessment (passive approaches vs. more active approaches); methods of disinvestment and value-based purchasing (de-listing, restricting treatment, price or reimbursement rate reductions, encouraging generic prescribing); lessons learnt from the various approaches; the potential role of coverage with evidence development; and the need for careful stakeholder management. Dedicated sections are provided with detailed coverage of policy approaches (with drug examples) from each country. Historically, countries have relied on 'passive disinvestment'; however, due to (1) the availability of new cost-effectiveness evidence, or (2) 'leakage' in drug utilisation, or (3) market failure in terms of price competition, there is an increasing focus towards 'active disinvestment'. Isolating low-value drugs that would create headroom for innovative new products to enter the market is also motivating disinvestment efforts by multiple parties, including industry. Historically, disinvestment has mainly taken the form of price reductions, especially when market failures are perceived to exist, and restricting treatment to subpopulations, particularly when a drug is no longer considered value for money. There is considerable experimentation internationally in mechanisms for disinvestment and the opportunity for countries to learn from each other. Ongoing evaluation of disinvestment strategies is essential, and ought to be reported in the peer-reviewed literature.

Socioeconomic differences in purchases of more vs. less healthy foods and beverages: Analysis of over 25,000 British households in 2010☆

PubMed Central

Pechey, Rachel; Jebb, Susan A.; Kelly, Michael P.; Almiron-Roig, Eva; Conde, Susana; Nakamura, Ryota; Shemilt, Ian; Suhrcke, Marc; Marteau, Theresa M.

2013-01-01

Socioeconomic inequalities in diet-related health outcomes are well-recognised, but are not fully explained by observational studies of consumption. We provide a novel analysis to identify purchasing patterns more precisely, based on data for take-home food and beverage purchases from 25,674 British households in 2010. To examine socioeconomic differences (measured by occupation), we conducted regression analyses on the proportion of energy purchased from (a) each of 43 food or beverage categories and (b) major nutrients. Results showed numerous small category-level socioeconomic differences. Aggregation of the categories showed lower SES groups generally purchased a greater proportion of energy from less healthy foods and beverages than those in higher SES groups (65% and 60%, respectively), while higher SES groups purchased a greater proportion of energy from healthier food and beverages (28% vs. 24%). At the nutrient-level, socioeconomic differences were less marked, although higher SES was associated with purchasing greater proportions of fibre, protein and total sugars, and smaller proportions of sodium. The observed pattern of purchasing across SES groups contributes to the explanation of observed health differences between groups and highlights targets for interventions to reduce health inequalities. PMID:23849275

Predictability in Pathological Gambling? Applying the Duplication of Purchase Law to the Understanding of Cross-Purchases Between Regular and Pathological Gamblers.

PubMed

Lam, Desmond; Mizerski, Richard

2017-06-01

The objective of this study is to explore the gambling participations and game purchase duplication of light regular, heavy regular and pathological gamblers by applying the Duplication of Purchase Law. Current study uses data collected by the Australian Productivity Commission for eight different types of games. Key behavioral statistics on light regular, heavy regular, and pathological gamblers were computed and compared. The key finding is that pathological gambling, just like regular gambling, follows the Duplication of Purchase Law, which states that the dominant factor of purchase duplication between two brands is their market shares. This means that gambling between any two games at pathological level, like any regular consumer purchases, exhibits "law-like" regularity based on the pathological gamblers' participation rate of each game. Additionally, pathological gamblers tend to gamble more frequently across all games except lotteries and instant as well as make greater cross-purchases compared to heavy regular gamblers. A better understanding of the behavioral traits between regular (particularly heavy regular) and pathological gamblers can be useful to public policy makers and social marketers in order to more accurately identify such gamblers and better manage the negative impacts of gambling.

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

PubMed

Hilsenrath, Peter; Eakin, Cynthia; Fischer, Katrina

2015-01-01

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

Teaching Grocery Store Purchasing Skills to Students with Intellectual Disabilities Using a Computer-Based Instruction Program

ERIC Educational Resources Information Center

Hansen, David L.; Morgan, Robert L.

2008-01-01

This research evaluated effects of a multi-media computer-based instruction (CBI) program designed to teach grocery store purchasing skills to three high-school students with intellectual disabilities. A multiple baseline design across participants used measures of computer performance mastery and grocery store probes to evaluate the CBI. All…

Advanced supplier partnership practices: a case study.

PubMed

Williams, B R

2000-05-01

This article describes how a supplier partnership was set up to avoid the typical purchasing relationship--price being inversely proportional to quantity and having the purchaser take all the risk of product obsolescence. The case study also describes how rate-based replenishment replaced time-based delivery, and how all these advantages were achieved at reduced administrative costs.

A Community-Based Social Marketing Campaign at Pacific University Oregon: Recycling, Paper Reduction, and Environmentally Preferable Purchasing

ERIC Educational Resources Information Center

Cole, Elaine J.; Fieselman, Laura

2013-01-01

Purpose: The purpose of this paper is to design a community-based social marketing (CBSM) campaign to foster sustainable behavior change in paper reduction, commingled recycling, and purchasing environmentally preferred products (EPP) with faculty and staff at Pacific University Oregon. Design/methodology/approach: A CBSM campaign was developed…

Medicare and Medicaid Programs; CY 2017 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements. Final rule.

PubMed

2016-11-03

This final rule updates the Home Health Prospective Payment System (HH PPS) payment rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor; effective for home health episodes of care ending on or after January 1, 2017. This rule also: Implements the last year of the 4-year phase-in of the rebasing adjustments to the HH PPS payment rates; updates the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking; implements the 2nd-year of a 3-year phase-in of a reduction to the national, standardized 60-day episode payment to account for estimated case-mix growth unrelated to increases in patient acuity (that is, nominal case-mix growth) between CY 2012 and CY 2014; finalizes changes to the methodology used to calculate payments made under the HH PPS for high-cost "outlier" episodes of care; implements changes in payment for furnishing Negative Pressure Wound Therapy (NPWT) using a disposable device for patients under a home health plan of care; discusses our efforts to monitor the potential impacts of the rebasing adjustments; includes an update on subsequent research and analysis as a result of the findings from the home health study; and finalizes changes to the Home Health Value-Based Purchasing (HHVBP) Model, which was implemented on January 1, 2016; and updates to the Home Health Quality Reporting Program (HH QRP).

Changes in quality, liking, and purchase intent of irradiated fresh-cut spinach during storage.

PubMed

Fan, Xuetong; Sokorai, Kimberly J B

2011-08-01

The use of ionizing radiation to enhance microbial safety of fresh spinach at a maximum dose of 4 kGy has been approved by the U.S. Food and Drug Administration (FDA). However, whether spinach can tolerate those high doses of radiation is unclear. Therefore, this study was conducted to investigate the effects of irradiation and storage on quality, liking, and purchase intent of fresh-cut spinach. The oxygen radical absorbance capacity values and total phenolic content were not consistently affected by irradiation. However, the ascorbic acid content of irradiated sample decreased rapidly during storage, resulting in these samples being lower in ascorbic acid content than controls after 7 and 14 d of storage at 4 °C. Sensory evaluation by a 50-member panel revealed that purchase intent and ratings for liking of appearance, aroma, texture, flavor, and overall were not affected by irradiation at doses up to 2 kGy. Therefore, irradiation at doses up to 2 kGy may be used to enhance microbial safety without affecting consumer acceptance or overall antioxidant values of irradiated spinach. Journal of Food Science © 2011 Institute of Food Technologists® No claim to original US government works.

Decision - making of Direct Customers Based on Available Transfer Capability

NASA Astrophysics Data System (ADS)

Quan, Tang; Zhaohang, Lin; Huaqiang, Li

2017-05-01

Large customer direct-power-purchasing is a hot spot in the electricity market reform. In this paper, the author established an Available Transfer Capability (ATC) model which takes uncertain factors into account, applied the model into large customer direct-power-purchasing transactions and improved the reliability of power supply during direct-power-purchasing by introducing insurance theory. The author also considered the customers loss suffered from power interruption when building ATC model, established large customer decision model, took purchasing quantity of power from different power plants and reserved capacity insurance as variables, targeted minimum power interruption loss as optimization goal and best solution by means of particle swarm algorithm to produce optimal power purchasing decision of large consumers. Simulation was made through IEEE57 system finally and proved that such method is effective.

From intelligence to evidence-based healthcare: a purchasing odyssey.

PubMed

Booth, A; Hey, S

1995-12-01

Since the appearance of the NHS Executive's guidance document, Purchasing Intelligence (1991), efforts have been concentrated on the development of 'purchasing intelligence facilities' staffed, in the main, by health librarians. However, the concept of 'intelligence' has a wider dimension that impacts upon the whole culture of an organization. The authors examine purchasing organizations against popular theories of organizational development. The characteristics of Handy's Task culture, with Athena as its patron, may be observed in many authorities. Using the results of two surveys, conducted in March 1995, they identify some key information management issues involving structure, tasks, technology and people. Skills in information 'transformation' must be acquired by all staff in purchasing authorities. The intelligence officer must become a modern-day Odysseus if the intelligence facility is to 'survive and thrive'.

Is nutritional quality of food-at-home purchases improving? 1969-2010: 40 years of household consumption surveys in France.

PubMed

Caillavet, France; Darmon, Nicole; Létoile, Flavie; Nichèle, Véronique

2018-02-01

The rise of nutrition-related diseases in developed countries prompts investigation into the role played by changing food patterns. Our aim was to observe changes in food-at-home purchases by French households and their impacts on nutritional quality over the past 40 years (1969-2010). Time-series of food-at-home purchases from representative samples of French households were built based on two sources of data: the INSEE National Food Survey (1969-1991) and the Kantar Food Consumption Panel (1989-2010). Food-at-home purchases were converted into energy and nutrients using the French CIQUAL food composition table. The nutritional quality of food-at-home purchases was estimated using the mean adequacy ratio (MAR) for 15 key nutrients. MAR was expressed per 2000 kcal to assess the nutrient density of food-at-home purchases. Between 1969 and 2010, food-at-home purchases showed dramatic changes in many food groups, with increasing processed vs raw products. The purchase of calories increased (+6.7%) and nutrient density improved (MAR per 2000 kcal + 12.9 points). However, this overall trend harbors heterogeneous patterns: food-at-home calories decreased and nutrient density improved up to 2002, but then calories increased while nutrient density stabilized. The nutritional quality of French households' food-at-home purchases improved over the last 40 years, as shown by increasing nutrient density. However, during the last decade, nutrient density ceased to increase and the purchase of calories increased, advocating a need for public action to promote healthier food purchasing patterns.

Heavy Drinkers and the Potential Impact of Minimum Unit Pricing-No Single or Simple Effect?

PubMed

Gill, J; Black, H; Rush, R; O'May, F; Chick, J

2017-11-01

To explore the potential impact of a minimum unit price (MUP: 50 pence per UK unit) on the alcohol consumption of ill Scottish heavy drinkers. Participants were 639 patients attending alcohol treatment services or admitted to hospital with an alcohol-related condition. From their reported expenditure on alcohol in their index week, and assuming this remained unchanged, we estimated the impact of a MUP (50 ppu) on future consumption. (Around 15% purchased from both the more expensive on-sale outlets (hotels, pubs, bars) and from off-sales (shops and supermarkets). For them we estimated the change in consumption that might follow MUP if (i) they continued this proportion of 'on-sales' purchasing or (ii) their reported expenditure was moved entirely to off-sale purchasing (to maintain consumption levels)). Around 69% of drinkers purchased exclusively off-sale alcohol at <50 ppu. Their drinking, post MUP, may reduce by a mean of 33%. For this group, from a population of very heavy, ill consumers, we were unable to show a differential effect across multiple deprivation quintiles. For other drinkers there might be no reduction, especially if after MUP there were many products priced close to 50 ppu. Moving away from on-sales purchases could support, for some, an increase in consumption. While a proportion of our harmed, heavy drinkers might be able to mitigate the impact of MUP by changing purchasing habits, the majority are predicted to reduce purchasing. This analysis, focusing specifically on harmed drinkers, adds a unique dimension to the evidence base informing current pricing policy. From drink purchasing data of heavy drinkers, we estimated the impact of legislating £0.50 minimum unit price. Over two thirds of drinkers, representing all multiple deprivation quintiles, were predicted to decrease alcohol purchasing; remainder, hypothetically, could maintain consumption. Our data address an important gap within the evidence base informing policy. © The Author 2017. Medical Council on Alcohol and Oxford University Press. All rights reserved.

Design and Promotion Strategy of Marketing Platform of Aquatic Auction based on Internet

NASA Astrophysics Data System (ADS)

Peng, Jianliang

For the online trade and promotion of aquatic products and related materials through the network between supply and demand, the design content and effective promotional strategies of aquatic auctions online marketing platform is proposed in this paper. Design elements involve the location of customer service, the basic function of the platform including the purchase of general orders, online auctions, information dissemination, and recommendation of fine products, human services, and payment preferences. Based on network and mobile e-commerce transaction support, the auction platform makes the transaction of aquatic products well in advance. The results are important practical value for the design and application of online marketing platform of aquatic auction.

Automated Metadata Extraction

DTIC Science & Technology

2008-06-01

provides a means for file owners to add metadata which can then be used by iTunes for cataloging and searching [4]. Metadata can be stored in different...based and contain AAC data formats [3]. Specifically, Apple uses Protected AAC to encode copy-protected music titles purchased from the iTunes Music...Store [4]. The files purchased from the iTunes Music Store include the following metadata. • Name • Email address of purchaser • Year • Album

Findings from Existing Data on the Department of Defense Industrial Base

DTIC Science & Technology

2014-01-01

the federal government. Leading purchasing textbooks recommend that buyers purchase no more than 30 percent of any sup- plier’s entire capacity, with...percentage of average total revenue FSRS and FPDS data can offer information on supplier dependency (Chart 22). Lead- ing purchasing textbooks (e.g...more contracts become subject to FSRS, may show a different level of sup- plier dependency. Industry Subaward Data 33 24RAND 150,000100,00050,000 90

Employer-Sponsored Health Insurance: Are Employers Good Agents for Their Employees?

PubMed Central

Peele, Pamela B.; Lave, Judith R.; Black, Jeanne T.; Evans III, John H.

2000-01-01

Employers in the United States provide many welfare-type benefits, such as life insurance, disability insurance, health insurance, and pensions, to their employees. Employers can be viewed as performing an agency role in purchasing pension, health, and other welfare benefits for their employees. An exploration of their competence in this role as agents for their employees indicates that large employers are very helpful to their employees in this arena. They seem to contribute to individual employees' welfare by providing them with valued services in purchasing health insurance. PMID:10834079

Employer-sponsored health insurance: are employers good agents for their employees?

PubMed

Peele, P B; Lave, J R; Black, J T; Evans, J H

2000-01-01

Employers in the United States provide many welfare-type benefits, such as life insurance, disability insurance, health insurance, and pensions, to their employees. Employers can be viewed as performing an agency role in purchasing pension, health, and other welfare benefits for their employees. An exploration of their competence in this role as agents for their employees indicates that large employers are very helpful to their employees in this arena. They seem to contribute to individual employees' welfare by providing them with valued services in purchasing health insurance.

Don't Preach. Practice! Value Laden Statements in Academic Sustainability Education

ERIC Educational Resources Information Center

Mulder, Karel F.

2010-01-01

Purpose: The slogan "Practice what you preach" denotes that people should behave in accordance with the values that they preach. For universities that teach sustainable development (SD), it implies that these institutes should apply major SD principles themselves for example by campus greening, green purchasing, etc. But is not…

A Blizzard of a Value

ERIC Educational Resources Information Center

Bostic, Jonathan D.

2015-01-01

"Who has been to Dairy Queen® and purchased a Blizzard?®" Ms. Bosetti asked her students. During the summer, Bosetti had seen many of her former and future students at the local Dairy Queen enjoying Blizzard desserts and wondered, "Which Blizzard size is the best value?" She used this context for a ratios and proportions task…

Malaria control under the Taliban regime: insecticide-treated net purchasing, coverage, and usage among men and women in eastern Afghanistan.

PubMed

Howard, Natasha; Shafi, Ahmad; Jones, Caroline; Rowland, Mark

2010-01-06

Scaling up insecticide-treated mosquito net (ITN) coverage is a key malaria control strategy even in conflict-affected countries 12. Socio-economic factors influence access to ITNs whether subsidized or provided free to users. This study examines reported ITN purchasing, coverage, and usage in eastern Afghanistan and explores women's access to health information during the Taliban regime (1996-2001). This strengthens the knowledge base on household-level health choices in complex-emergency settings. Fifteen focus group discussions (FGDs) and thirty in-depth interviews were conducted with men and women from ITN-owning and non-owning households. FGDs included rank ordering, pile sorting and focused discussion of malaria knowledge and ITN purchasing. Interviews explored general health issues, prevention and treatment practices, and women's malaria knowledge and concerns. Seven key informant interviews with health-related workers and a concurrent survey of 200 ITN-owning and 214 non-owning households were used to clarify or quantify findings. Malaria knowledge was similar among men and women and ITN owners and non-owners. Women reported obtaining health information through a variety of sources including clinic staff, their husbands who had easier access to information, and particularly female peers. Most participants considered ITNs very desirable, though not usually household necessities. ITN owners reported more household assets than non-owners. Male ITN owners and non-owners ranked rugs and ITNs as most desired, while women ranked personal assets such as jewellery highest. While men were primarily responsible for household decision-making and purchasing, older women exerted considerable influence. Widow-led and landless households reported most difficulties purchasing ITNs. Most participants wanted to buy ITNs only if they could cover all household members. When not possible, preferential usage was given to women and children. Despite restricted access to health facilities and formal education, Afghan women were surprisingly knowledgeable about the causes of malaria and the value of ITNs in prevention. Inequities in ITN usage were noted between rather than within households, with some unable to afford even one ITN and others not wanting ITNs unless all household members could be protected. Malaria knowledge thus appears a lesser barrier to ITN purchasing and coverage in eastern Afghanistan than are pricing and distribution strategies.

Malaria control under the Taliban regime: insecticide-treated net purchasing, coverage, and usage among men and women in eastern Afghanistan

PubMed Central

2010-01-01

Background Scaling up insecticide-treated mosquito net (ITN) coverage is a key malaria control strategy even in conflict-affected countries [1,2]. Socio-economic factors influence access to ITNs whether subsidized or provided free to users. This study examines reported ITN purchasing, coverage, and usage in eastern Afghanistan and explores women's access to health information during the Taliban regime (1996-2001). This strengthens the knowledge base on household-level health choices in complex-emergency settings. Methods Fifteen focus group discussions (FGDs) and thirty in-depth interviews were conducted with men and women from ITN-owning and non-owning households. FGDs included rank ordering, pile sorting and focused discussion of malaria knowledge and ITN purchasing. Interviews explored general health issues, prevention and treatment practices, and women's malaria knowledge and concerns. Seven key informant interviews with health-related workers and a concurrent survey of 200 ITN-owning and 214 non-owning households were used to clarify or quantify findings. Results Malaria knowledge was similar among men and women and ITN owners and non-owners. Women reported obtaining health information through a variety of sources including clinic staff, their husbands who had easier access to information, and particularly female peers. Most participants considered ITNs very desirable, though not usually household necessities. ITN owners reported more household assets than non-owners. Male ITN owners and non-owners ranked rugs and ITNs as most desired, while women ranked personal assets such as jewellery highest. While men were primarily responsible for household decision-making and purchasing, older women exerted considerable influence. Widow-led and landless households reported most difficulties purchasing ITNs. Most participants wanted to buy ITNs only if they could cover all household members. When not possible, preferential usage was given to women and children. Conclusions Despite restricted access to health facilities and formal education, Afghan women were surprisingly knowledgeable about the causes of malaria and the value of ITNs in prevention. Inequities in ITN usage were noted between rather than within households, with some unable to afford even one ITN and others not wanting ITNs unless all household members could be protected. Malaria knowledge thus appears a lesser barrier to ITN purchasing and coverage in eastern Afghanistan than are pricing and distribution strategies. PMID:20053281

Model-based estimates of risks of disease transmission and economic costs of seven injection devices in sub-Saharan Africa.

PubMed Central

Ekwueme, Donatus U.; Weniger, Bruce G.; Chen, Robert T.

2002-01-01

OBJECTIVE: To investigate and compare seven types of injection devices for their risks of iatrogenic transmission of bloodborne pathogens and their economic costs in sub-Saharan Africa. METHODS: Risk assumptions for each device and cost models were constructed to estimate the number of new hepatitis B virus (HBV) and human immunodeficiency virus (HIV) infections resulting from patient-to-patient, patient-to-health care worker, and patient-to-community transmission. Costs of device purchase and usage were derived from the literature, while costs of direct medical care and lost productivity from HBV and HIV disease were based on data collected in 1999 in Côte d'Ivoire, Ghana, and Uganda. Multivariate sensitivity analyses using Monte Carlo simulation characterized uncertainties in model parameters. Costs were summed from both the societal and health care system payer's perspectives. FINDINGS: Resterilizable and disposable needles and syringes had the highest overall costs for device purchase, usage, and iatrogenic disease: median US dollars 26.77 and US dollars 25.29, respectively, per injection from the societal perspective. Disposable-cartridge jet injectors and automatic needle-shielding syringes had the lowest costs, US dollars 0.36 and US dollars 0.80, respectively. Reusable-nozzle jet injectors and auto-disable needle and syringes were intermediate, at US dollars 0.80 and US dollars 0.91, respectively, per injection. CONCLUSION: Despite their nominal purchase and usage costs, conventional needles and syringes carry a hidden but huge burden of iatrogenic disease. Alternative injection devices for the millions of injections administered annually in sub-Saharan Africa would be of value and should be considered by policy-makers in procurement decisions. PMID:12481207

Convenience-based food purchase patterns: identification and associations with dietary quality, sociodemographic factors and attitudes.

PubMed

Peltner, Jonas; Thiele, Silke

2018-02-01

The present study aimed to derive food purchase patterns considering the convenience level of foods. Associations between identified patterns and dietary quality were analysed, as well as household characteristics associated with the dietary patterns. A Convenience Food Classification Scheme (CFCS) was developed. After classifying basic food groups into the CFCS, the formed groups were used to apply a factor analysis to identify convenience-based food purchase patterns. For these patterns nutrient and energy densities were examined. Using regression analysis, associations between the adherence to the patterns and household characteristic and attitude variables were analysed. The study used representative German food purchase data from 2011. Approximately 12 million purchases of 13 131 households were recorded in these data. Three convenience-based patterns were identified: a low-convenience, a semi-convenience and a ready-to-eat food pattern. Tighter adherence to the semi-convenience pattern was shown to result in the lowest nutrient and highest energy densities. Important factors influencing adherence to the patterns were household size, presence of children and attitudes. Working full-time was negatively associated with adherence to the low-convenience pattern and positively with the ready-to-eat pattern. Convenience foods were an important part of households' food baskets which in some cases led to lower nutritional quality. Therefore, it is important to offer convenience foods higher in nutrient density and lower in energy density. Interventions targeted on enhancing cooking skills could be an effective strategy to increase purchases of unprocessed foods, which, in turn, could also contribute to an improved diet quality.

Naturalistic assessment of demand for cigarettes, snus, and nicotine gum

PubMed Central

Stein, Jeffrey S.; Wilson, A. George; Koffarnus, Mikhail N.; Judd, Michael C.

2017-01-01

Rationale Behavioral economic measures of demand provide estimates of tobacco product abuse liability and may predict effects of policy-related price regulation on consumption of existing and emerging tobacco products. Objective In the present study, we examined demand for snus, a smokeless tobacco product, in comparison to both cigarettes and medicinal nicotine. We used both a naturalistic method in which participants purchased these products for use outside the laboratory, as well as laboratory-based self-administration procedures. Methods Cigarette smokers (N = 42) used an experimental income to purchase their usual brand of cigarettes and either snus or gum (only one product available per session) across a range of prices, while receiving all products they purchased from one randomly selected price. In a separate portion of the study, participants self-administered these products during laboratory-based, progressive ratio sessions. Result Demand elasticity (sensitivity of purchasing to price) was significantly greater for snus than cigarettes. Elasticity for gum was intermediate between snus and cigarettes but was not significantly different than either. Demand intensity (purchasing unconstrained by price) was significantly lower for gum compared to cigarettes, with no significant difference observed between snus and cigarettes. Results of the laboratory-based, progressive ratio sessions were generally discordant with measures of demand elasticity, with significantly higher “breakpoints” for cigarettes compared to gum and no significant differences between other study products. Moreover, breakpoints and product purchasing were generally uncorrelated across tasks. Conclusions Under naturalistic conditions, snus appears more sensitive to price manipulation than either cigarettes or nicotine gum in existing smokers. PMID:27730273

Anesthesiologists and anesthetist: are we paying for outcome or process?

PubMed

Rutsohn, Phil

2005-01-01

The concept of Value Exchange is fundamental to any discipline that focuses on interactions between providers and consumers. In both the study of Marketing and the study of Economics, one learns that a producer and consumer will engage in an exchange relationship only so long as the value/cost relationship is positive. Once the cost of the exchange is equal to the value of that exchange, further economic activity is irrational. In a market-based economy, the market is obviously the regulator unless there is some imperfection inhibiting the interaction of the buyer and seller. When there is an imperfection, it is the government's responsibility to intervene and function as a proxy promoting rational buying and selling. In this paper, the author will attempt to demonstrate that the consumer has been economically irrational when purchasing anesthesia services and government has been slow and minimally effective when intervening to rectify this market imperfection.

Beyond cost: 'responsible purchasing' of managed care by employers.

PubMed

Lo Sasso, A T; Perloff, L; Schield, J; Murphy, J J; Mortimer, J D; Budetti, P P

1999-01-01

We explore the extent of "responsible purchasing" by employers--the degree to which employers collect and use nonfinancial information in selecting and managing employee health plans. Most firms believe that they have some responsibility for assessing the quality of the health plans they offer. Some pay attention to plan characteristics such as the ability to provide adequate access to providers and services and scores on enrollee satisfaction surveys. A more limited but still notable number of firms take specific actions based on responsible purchasing information. Because of countervailing pressures, however, it is not clear whether or not the firms most involved in responsible purchasing are signaling a developing trend.

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

PubMed

Sposato, Luciano A; Saposnik, Gustavo

2012-01-01

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

Trends in childhood vaccine purchase costs in the US public sector: 1996-2014.

PubMed

Chen, Weiwei; Messonnier, Mark; Zhou, Fangjun

2016-09-07

While vaccination remains as one of the most cost-effective preventive strategies, the cost of fully immunizing a child has grown considerably over the last few decades. This study examines trends in non-influenza childhood vaccine purchase costs in the public sector from 1996 to 2014. Non-influenza vaccine purchase cost per child for children aged 0 through 18years was calculated based on public-sector purchase prices. Purchase cost changes were then decomposed into changes attributable to recommendation updates and changes attributable to price variation. The study analyzed the growth rate of combination vaccine prices separately and compared these prices with the sum of prices of component vaccines. It is found that the average annual growth rate of non-influenza vaccine purchase cost per child during 1996-2014 was 12.6%. The growth rate attributable to price changes was 1.0% on average. Combination vaccine prices showed greater variation. The study concludes that vaccine price variation was one but a minor reason for purchase cost changes. Recommendation updates, particularly the introduction of new vaccines, played a much larger role in raising the purchase costs. If the 12.6% annual growth rate found during 1996-2014 in the study continues to apply, the purchase costs of childhood vaccines may more than double by 2020. Copyright © 2016 Elsevier Ltd. All rights reserved.

Application for disability pension and change in use of prescribed drugs. A regional Danish cohort study.

PubMed

Petersen, Thomas T; Fonager, Kirsten; Bøggild, Henrik; Pedersen, Lars; Mortensen, Jens T

2009-06-01

To investigate if a pending application for disability pension had an influence on the applicant's purchase of medical drugs, with a particular focus on musculoskeletal disorders and the use of painkillers. We performed a registry-based follow-up study including 12,020 applicants for disability pension in a Danish county from 1995 to 2000 and linked this information to a database of drug prescriptions. Purchase of drug was calculated for the 6-month period just before the decision and for the 6-month period 2 years later. Changes in a 2-year time period were estimated by differences in purchase rates. Furthermore, the proportion of applicants with an increased purchase of drugs and the proportion of applicants who ceased buying drugs were estimated. The results were stratified by diagnosis and result of application (awarded/rejected). The analyses were furthermore restricted to musculoskeletal disorders and the use of painkillers. At baseline 81% had a purchase and after the 2-year time period 11% ceased buying prescribed drugs. Half of all applicants increased the purchase of drugs. For musculoskeletal disorders one third had an increased purchase rate of painkillers while one fourth ceased purchase of drugs with variations in different diagnostic subgroups. The major changes of drug purchase after a pending application for disability pension are probably ascribed to characteristics of the diseases underlying the disability.

Activity space-based measures of the food environment and their relationships to food purchasing behaviours for young urban adults in Canada.

PubMed

Widener, Michael J; Minaker, Leia M; Reid, Jessica L; Patterson, Zachary; Ahmadi, Tara Kamal; Hammond, David

2018-03-16

To examine the potential links between activity spaces, the food retail environment and food shopping behaviours for the population of young, urban adults. Participants took part in the Canada Food Study, which collected information on demographics, food behaviour, diet and health, as well as an additional smartphone study that included a seven-day period of logging GPS (global positioning system) location and food purchases. Using a time-weighted, continuous representation of participant activity spaces generated from GPS trajectory data, the locations of food purchases and a geocoded food retail data set, negative binomial regression models were used to explore what types of food retailers participants were exposed to and where food purchases were made. Toronto, Montreal, Vancouver, Edmonton and Halifax, Canada. Young adults aged 16-30 years (n 496). These participants were a subset of the larger Canada Food Study. Demographics, household food shopper status and city of residence were significantly associated with different levels of exposure to various types of food retailers. Food shopping behaviours were also statistically significantly associated with demographics, the activity space-based food environment, self-reported health and city of residence. The study confirms that food behaviours are related to activity space-based food environment measures, which provide a more comprehensive accounting of food retail exposure than home-based measures. In addition, exposure to food retail and food purchasing behaviours of an understudied population are described.