Expenditure Categories Research Articles

Government Expenditure and Economic Growth of Nepal

Purpose: This study aims to analyze the relationship between various categories of government expenditure and economic growth in Nepal. The purpose is to understand how these defense, health, agriculture and education expenditures influence economic performance and offer insights for more effective resource allocation.Methods: This research used a combination of descriptive and causal research designs, using secondary data sourced from published reports. Data from 1976 to 2022 AD were selected for its comprehensive data availability and analyzed.Results: The findings reveal that defense expenditure has a negative and significant association with economic growth, suggesting that high levels of defense spending are detrimental to economic development. Conversely, health and education expenditures show positive and significant relationships with economic growth, highlighting the importance of investing in human capital for fostering sustainable development. Agriculture expenditure, although positively related to economic growth, is statistically insignificant, indicating the need for policy refinements to enhance its impact. Conclusion: The study underscores the necessity for strategic reallocation of government resources. Reducing defense expenditures and increasing investments in health, education and agriculture are essential for promoting robust and sustainable economic growth.

Household spending diversity, aggregation, and the value of product variety

This paper studies the diversity of household consumption spending, i.e. how widely households distribute their spending across different types of goods. Using detailed UK expenditure data (1990–2015), we show that the diversity of household spending rises in income up to a certain level and then declines as richer households increasingly concentrate their spending on specific expenditure categories. As these categories differ across households, spending diversity on the aggregate level can keep rising in income while spending diversity on the household level falls. We build a model with heterogeneous nonhomothetic preferences that can explain the observed patterns, highlighting the role of aggregation. Our model shows that ignoring preference heterogeneity and assuming representative households leads to a (potentially very large) underestimation of the value of product variety. Estimating the welfare effects of trade or innovation policies therefore requires to appropriately account for the empirically observed heterogeneity and nonhomotheticity of preferences.

Surgical treatment of liver cancer and pancreatic cancer under the China Healthcare Security Diagnosis Related Groups payment system.

Data from the World Health Organization's International Agency for Research on Cancer reported that China had the highest prevalence of cancer and cancer deaths in 2022. Liver and pancreatic cancers accounted for the highest number of new cases. Real-world data (RWD) is now widely preferred to traditional clinical trials in various fields of medicine and healthcare, as the traditional research approach often involves highly selected populations and interventions and controls that are strictly regulated. Additionally, research results from the RWD match global reality better than those from traditional clinical trials. To analyze the cost disparity between surgical treatments for liver and pancreatic cancer under various factors. This study analyzed RWD 1137 cases within the HB1 group (patients who underwent pancreatectomy, hepatectomy, and/or shunt surgery) in 2023. It distinguished different expenditure categories, including medical, nursing, technical, management, drug, and consumable costs. Additionally, it assessed the contribution of each expenditure category to total hospital costs and performed cross-group comparisons using the non-parametric Kruskal-Wallis test. This study used the Steel-Dwass test for post-hoc multiple comparisons and the Spearman correlation coefficient to examine the relationships between variables. The study found that in HB11 and HB13, the total hospitalization costs were significantly higher for pancreaticoduodenectomy than for pancreatectomy and hepatectomy. Although no significant difference was observed in the length of hospital stay between patients who underwent pancreaticoduodenectomy and pancreatectomy, both were significantly longer than those who underwent liver resection. In HB15, no significant difference was observed in the total cost of hospitalization between pancreaticoduodenectomy and pancreatectomy; however, both were significantly higher than those in hepatectomy. Additionally, the length of hospital stay was significantly longer for patients who underwent pancreaticoduodenectomy than for those who underwent pancreatectomy or liver resection. China Healthcare Security Diagnosis Related Groups payment system positively impacts liver and pancreatic cancer surgeries by improving medical quality and controlling costs. Further research could refine this grouping system and ensure continuous effectiveness and sustainability.

The impact of the expanded health insurance coverage policy on healthcare spending: evidence from Korea

BackgroundSouth Korea’s National Health Insurance (NHI) system pursues universal health coverage, but it has not been able to alleviate patients’ financial burden owing to limited coverage and a high proportion of out-of-pocket expenses. In 2017, the government announced a plan to strengthen universality by providing coverage for all unincluded services, expanding coverage, and alleviating household financial burden. We aimed to evaluate the effect of “Moon Care” with a focus on changes in health expenditures following policy implementation, and to provide empirical evidence for future policies to strengthen the NHI system’s universality.MethodsUsing data from the 2016 and 2018 Korea Health Panel (KHP), we established a treatment group affected by the policy and an unaffected control group; we ensured homogeneity between the groups using propensity score matching (PSM). Subsequently, we examined changes in NHI payments, non-payments, and out-of-pocket payments (OOP); we performed difference-in-differences (DID) analysis to evaluate the policy’s effect.ResultsFollowing policy implementation, the control group had a higher increase than the treatment group in all categories of health expenditures, including NHI payments, non-payments, and OOP. We noted significant decreases in all three categories of health expenditures when comparing the differences before and after policy implementation, as well as between the treatment and control groups. However, we witnessed a significant decrease in the interaction term, which confirms the policy’s effect, but only for non-payments.ConclusionsWe observed the policy’s intervention effect over time as a decrease in non-payments, on the effectivity of remunerating covered medical services. However, the policy did not work for NHI payments and OOP, suggesting that it failed to control the creation of new non-covered services as noncovered services were converted into covered ones. Thus, it is crucial to discuss the financial spending of health insurance regarding the inclusion of non-covered services in the NHI benefits package.

The impact of Medicaid expansion on state expenditures through the COVID-19 era.

To investigate the impact of Medicaid expansion on state expenditures through the end of 2022. We used data from the National Association of State Budget Officers (NASBO)'s State Expenditure Report, Kaiser Family Foundation (KFF)'s Medicaid expansion tracker, US Bureau of Labor Statistics data (BLS), US Bureau of Economic Analysis data (BEA), and Pandemic Response Accountability Committee Oversight (PRAC). We investigated spending per capita (by state population) across seven budget categories, including Medicaid spending, and four spending sources. We performed a difference-in-differences (DiD) analysis that compared within-state changes in spending over time in expansion and nonexpansion states to estimate the effect of Medicaid expansion on state budgets. We adjusted for annual state unemployment rate, annual state per capita personal income, and state spending of Coronavirus Relief Funds (CRF) from 2020 to 2022 and included state and year fixed effects. We linked annual state-level data on state-reported fiscal year expenditures from NASBO with state-level characteristics from BLS and BEA data and with CRF state spending from PRAC. Medicaid expansion was associated with an average increase of 21% (95% confidence interval [CI]: 16%-25%) in per capita Medicaid spending after Medicaid expansion among states that expanded prior to 2020. After inclusion of an interaction term to separate between the coronavirus disease (COVID) era (2020-2022) and the prior period following expansion (2015-2019), we found that although Medicaid expansion led to an average increase of 33% (95% CI: 21%-45%) in federal funding of state expenditures in the post-COVID years, it was not significantly associated with increased state spending. There was no evidence of crowding out of other state expenditure categories or a substantial impact on total state spending, even in the COVID-19 era. Increased federal expenditures may have shielded states from substantial budgetary impacts.

Association of Opioid and Concurrent Benzodiazepine, Skeletal Muscle Relaxant, and Gabapentinoid Usage on Healthcare Expenditure and Resource Utilization: A Serial Cross-Sectional Study, 2009 to 2019.

Healthcare providers may be utilizing central nervous system (CNS) depressants to reduce opioid use due to recent changes in public policy. Combination use of these agents with opioids increases the risk of respiratory depression and death. Healthcare expenditures by individuals using these drug combinations have not been previously quantified. We sought to characterize healthcare costs and expenditures associated with a population reporting concurrent CNS depressants and opioid use compared with nonopioid analgesics in the United States from 2009 to 2019. A serial cross-sectional design was used to compare the healthcare expenditures of adult Medical Expenditure Panel Survey respondents who were prescribed nonopioid analgesics, opioids only, opioids/benzodiazepines (BZD), opioids/BZD/skeletal muscle relaxants (SMR), or opioids/gabapentin (gaba) using pooled data from 2009 to 2019. Expenditure (cost and resource utilization) categories included inpatient, outpatient, office-based, and prescription medicine. Average marginal effects were used to compare survey-weighted annual costs and resource utilizations across the groups as compared to nonopioid analgesic respondents, adjusted for covariates. A weighted total of 34 241 838 individuals were identified. Most were opioid-only respondents (46.5%), followed by nonopioid analgesic (43.4%), opioid/BZD (5.3%), opioid-gaba (3.5%), and opioid/BZD/SMR respondents (1.3%). In comparison to the study groups with nonopioid analgesics, opioid-gaba users had the highest significant incremental cost difference among the different pairings (+$11 684, P < .001). Opioid-gaba, opioid/BZD, and opioid/BZD/SMR respondents had significantly higher inpatient, emergency department, and prescription drug costs and use compared to nonopioid analgesic respondents. Opioid-only respondents had higher outpatient and office-based costs and visits compared to nonopioid analgesic respondents. As healthcare providers seek to utilize fewer opioids for pain management, attention must be paid to ensuring safe and effective use of concurrent CNS depressants to mitigate high healthcare costs and burden.

The Coholding Puzzle: New Evidence from Transaction-Level Data

Abstract Why do individuals pay debt interest when they could use their savings to pay down the debt? We explore why individuals “cohold” debt and savings using detailed and highly disaggregated daily-level data on household finances. We find that coholding mostly occurs in short spells within the month and the level of coholding is typically modest. Periods of coholding are not associated with shocks at the individual level. We show that mental accounting has a role to play in explaining coholding, in particular how individuals allocate different categories of expenditure to accounts in credit and debit.

Shariah Compliance in Malay Wedding Ceremony Expenditure

Traditional Malay weddings are fast becoming an expensive affair these days, mainly due to escalation in its overall expenditure, and compounded by some additional rituals, overpriced wedding trappings and services by event managers. While the trend to spend lavishly during weddings is on the rise, the Malay community seems to ignore concerns related with wastefulness which is against Islamic values. This article examines wedding expenditures in Islam and attempts to justify its excessiveness vis-à-vis shariah compliance through the qualitative research method. The data have been collected by interviewing the wedding planners and shariah experts. Data from interviews are analysed by using the thematic content analysis method. These interviews revealed that the Malay community tends to justify high expenditure in four different categories of expenditures. Four categories are examined from the shariah perspective with regard to shariah ideas and validation from shariah experts. Theoretically, Islam acknowledges the Muslims’ right to own and manage their property according to their abilities. The Islamic concept of spending focuses on halal resources, i.e., wholesome, good, and beneficial things, which bring about spiritual rewards. Wedding expenditure is considered shariah-compliant so long as it adheres to the basic concept of not glamourising events and resources not wasted on rituals considered unIslamic. Extra expenditure such as beauty treatment, beautification, dais and photography requirement must comply with relevant shariah edicts. As for the moral aspect of the wedding, the study concludes that the ceremony is only considered shariah-compliant if it conforms to the rules of modesty, gender segregation, awrah, wearing of jewellery, and entertainment. Further, traditional wedding dances should not contain inappropriate elements, and songs sung on the occasion should not contain inappropriate and crude language.

Comprobación de la ley de Engel en el patrón de consumo de loshabitantes de Tangail Sadar Upazila en Bangladesh

One of the most enduring relationships in economics is income-food expenditure relationship which is known as Engel’s law. According to the law, as a family's income grows, so does the percentage of income spend on food diminishes, despite the fact that the actual amount grows. However, in the 21st century expenditure categories have grown to include many things that weren't around in Engel's day (automobiles, health insurance, and mobile phones, for example). Hence, at more than 150 years after economists and policy makers have a tireless attention for its work, especially its applicability and relevance in different economic contexts. Thus, the study aims to investigate the relevance of the Law in Tangail Sadar Upazial of Bangladesh. To pursue the study, required data is collected from Tangail Sadar Upazial by following multi-stage sampling technique. After analyzing data, it is revealed that Engel’s Law is applicable in the study area.

Covid-19 psychological distress: Analysis of antipsychotic drugs’ use in an Italian population sample

The current pandemic, in addition to putting a strain on healthcare systems and global economies, has exacerbated psychiatric problems and undermined the mental health of many individuals. In an Italian cohort, this phenomenon has been assessed through a retrospective study aimed at evaluating the consumption and costs of antipsychotic drugs between 2020 and 2022. All dispensations made in local pharmacies accessible to the public have been extracted from a database called 'Sistema Tessera Sanitaria', which covers a population of approximately one million people residents in the ASL Napoli 3 Sud. Consumption data expressed in defined daily dose (DDD) and expenditure data expressed in Euro have been extrapolated. The results in the years 2020-2021 were relatively consistent, with consumption and expenditure decreasing slightly from 2020 to 2021. In 2022, the results showed a decrease in consumption and expenditure (2,706,951.07 DDD and €1,700,897.47) representing the reduced accessibility of patients to the healthcare facilities due to the pandemic. However, it should be noted that the antipsychotic drug aripiprazole showed an upward trend, registering an increase in consumption. Despite expectations of increased consumption of antipsychotic medications, real-world evidence indicated a different phenomenon, with the pandemic seemingly not affecting the consumption of these drugs. The difficulty in accessing care and medical appointments has probably influenced this data, masking the therapeutic needs of citizens. It will be necessary to assess in the coming years, as normal clinical activity resumes, whether there will be a growing consumption of these medications, which represent one of the main expenditure categories for the National Healthcare System.

The impact of tax expenditures on economic growth: The US experience

In the last decade, assessing the tax expenditures’ economic efficiency has grown in importance due to the increasing number of situations where stakeholders use tax benefits for personal enrichment. The problem is aggravated by the very nature of tax expenditures, which represent budget revenue losses. The expediency of tax expenditures can be proved by estimating their impact on economic growth. The paper aims to measure such impact using the case of the USA. Methodologically, the study relies on Barro’s conception of endogenous growth. The study applies econometric methods of analysis. The data for the study is taken from the Global Tax Expenditures Database (GTED), the U.S. Department of the Treasury, the U.S. Bureau of Economic Analysis, and the U.S. Census Bureau for 1998–2022. The results indicate no correlation between the share of tax expenditures in a specific sphere in the total amount and their efficiency (the strength of the positive impact on GDP). For instance, the tax expenditures in commerce and housing have the greatest share (35.4 %), yet their impact is relatively weak compared to other categories of tax expenditures: 1 dollar of expenditures induces a 0.04 dollar increase in GDP. At the same time, tax expenditures in the social sphere with an insubstantial share of 2 % generate a 10 times higher return (a 0.49 dollar increase in GDP per 1 dollar of expenditures). Therefore, the structure of tax expenditures with an explicit social orientation appears to be the most preferable for the USA.

Effects of Drug Price Changes on Patient Expenditure: Evidence from China’s Zero Markup Drug Policy

Global society is dedicated to lowering healthcare costs. In China, the rapid growth in drug expenditure has been a major factor in the surge in patient expenditure. To alleviate the negative effect of this phenomenon, China launched the zero markup drug policy (ZMDP) in 2009. However, there is limited direct evidence of its effectiveness in reducing patient costs. Using claims data from January 2012 through May 2016 for enrollees in China’s New Rural Cooperative Medical Scheme (NRCMS) in 25 counties, we investigated the changes in patient expenditure before and after the ZMDP’s implementation. We found that the ZMDP significantly reduced outpatients’ total expenditure (23.66%), reimbursable expenses (24.42%), out-of-pocket (OOP) costs (54.62%), and the OOP costs ratio (14%). Compared with outpatients, the ZMDP’s implementation significantly reduced inpatients’ total expenditure (5.82%) and reimbursable expenses (8.61%) but showed no significant relationship between OOP costs and the OOP costs ratio. Thus, it is important to distinguish outpatients from inpatients, as the ZMDP only significantly reduces outpatients’ OOP costs. We believe that the difference between outpatients and inpatients in the share of drug expenditure (in the total expenditure) when visiting doctors and the shift from drug expenditure to other expenditure categories can explain the ineffectiveness of the policy for inpatients. Therefore, future reforms should focus on reducing inpatient costs.

The Comprehensive Primary Care Plus Model and Health Care Spending, Service Use, and Quality

Implemented in 18 regions, Comprehensive Primary Care Plus (CPC+) was the largest US primary care delivery model ever tested. Understanding its association with health outcomes is critical in designing future transformation models. To test whether CPC+ was associated with lower health care spending and utilization and improved quality of care. Difference-in-differences regression models compared changes in outcomes between the year before CPC+ and 5 intervention years for Medicare fee-for-service beneficiaries attributed to CPC+ and comparison practices. Participants included 1373 track 1 (1 549 585 beneficiaries) and 1515 track 2 (5 347 499 beneficiaries) primary care practices that applied to start CPC+ in 2017 and met minimum care delivery and other eligibility requirements. Comparison groups included 5243 track 1 (5 347 499 beneficiaries) and 3783 track 2 (4 507 499 beneficiaries) practices, matched, and weighted to have similar beneficiary-, practice-, and market-level characteristics as CPC+ practices. Two-track design involving enhanced (higher for track 2) and alternative payments (track 2 only), care delivery requirements (greater for track 2), data feedback, learning, and health information technology support. The prespecified primary outcome was annualized Medicare Part A and B expenditures per beneficiary per month (PBPM). Secondary outcomes included expenditure categories, utilization (eg, hospitalizations), and claims-based quality-of-care process and outcome measures (eg, recommended tests for patients with diabetes and unplanned readmissions). Among the CPC+ patients, 5% were Black, 3% were Hispanic, 87% were White, and 5% were of other races (including Asian/Other Pacific Islander and American Indian); 85% of CPC+ patients were older than 65 years and 58% were female. CPC+ was associated with no discernible changes in the total expenditures (track 1: $1.1 PBPM [90% CI, -$4.3 to $6.6], P = .74; track 2: $1.3 [90% CI, -$5 to $7.7], P = .73), and with increases in expenditures including enhanced payments (track 1: $13 [90% CI, $7 to $18], P < .001; track 2: $24 [90% CI, $18 to $31], P < .001). Among secondary outcomes, CPC+ was associated with decreases in emergency department visits starting in year 1, and in acute hospitalizations and acute inpatient expenditures in later years. Associations were more favorable for practices also participating in the Medicare Shared Savings Program and independent practices. CPC+ was not associated with meaningful changes in claims-based quality-of-care measures. Although the timing of the associations of CPC+ with reduced utilization and acute inpatient expenditures was consistent with the theory of change and early focus on episodic care management of CPC+, CPC+ was not associated with a reduction in total expenditures over 5 years. Positive interaction between CPC+ and the Shared Savings Program suggests transformation models might be more successful when provider cost-reduction incentives are aligned across specialties. Further adaptations and testing of primary care transformation models, as well as consideration of the larger context in which they operate, are needed.

Health Care Expenditures for Black and White US Adults Living Under Similar Conditions

Evidence suggests that racial disparities in health outcomes disappear or diminish when Black and White adults in the US live under comparable living conditions; however, whether racial disparities in health care expenditures concomitantly disappear or diminish is unknown. To examine whether disparities in health care expenditures are minimized when Black and White US adults live in similar areas of racial composition and economic condition. This cross-sectional study used a nationally representative sample of 7062 non-Hispanic Black or White adults who live in 2238 of 2275 US census tracts with a 5% or greater Black population and who participated in the Medical Expenditure Panel Study (MEPS) in 2016. Differences in total health care expenditures and 6 specific categories of health care expenditures were assessed. Two-part regression models compared expenditures between Black and White adults living in the same Index of Concentration at the Extremes (ICE) quintile, a measure of racialized economic segregation. Estimated dollar amount differences in expenditures were calculated. All analyses were weighted to account for the complex sampling design of the MEPS. Data analysis was performed from December 1, 2019, to August 7, 2023. Self-reported non-Hispanic Black or non-Hispanic White race. Presence and amount of patient out-of-pocket and insurance payments for annual total health care expenditures; office-based, outpatient, emergency department, inpatient hospital, or dental visits; and prescription medicines. ICE quintile 5 (Q5) reflected tracts that were mostly high income with mostly White individuals, whereas Q1 reflected tracts that were mostly low income with mostly Black individuals. A total of 7062 MEPS respondents (mean [SD] age, 49 [18] years; 33.1% Black and 66.9% White; 56.1% female and 43.9% male) who lived in census tracts with a 5% or greater Black population in 2016 were studied. In Q5, Black adults had 56% reduced odds of having any health care expenditures (odds ratio, 0.44; 95% CI, 0.27-0.71) compared with White adults, at an estimated $2145 less per year, despite similar health status. Among those in Q5 with any expenditures, Black adults spent 30% less on care (cost ratio, 0.70; 95% CI, 0.56-0.86). In Q3 (most racially and economically integrated), differences in total annual health care spending were minimal ($79 annually; 95% CI, -$1187 to $1345). In this cross-sectional study of Black and White adults in the US, health care expenditure disparities diminished or disappeared under conditions of both racial and economic equity and equitable health care access; in areas that were mostly high income and had mostly White residents, Black adults spent substantially less. Results underscore the continuing need to recognize place as a contributor to race-based differences in health care spending.

Пріоритети бюджетної політики в умовах воєнного стану та повоєнного відновлення України

Introduction. Various financial and economic crises, shocks, including the introduction of martial law, affect the state of implementation and fundamentally change the priorities of budget policy, and therefore require timely adjustment of the main directions and macro indicators. Fiscal risks are increasing, exogenous and endogenous factors are exerting a powerful influence on the financial and budgetary system, which requires special attention to the analysis of the state of formation of budget revenues, determination of priorities, rational distribution and effective use of budget expenditures. Problem Statement. Budgetary policy under martial law has not been sufficiently studied. The outlined problems require in-depth study, as this policy must be rational, efficient, effective, take into account the conditions of the war and foresee real ways of further development in the post-war period. The purpose is to develop an algorithm for further development, to form an effective mechanism for the distribution and redistribution of budget funds, to increase the efficiency and effectiveness of budget policy during the recovery period of Ukraine based on an analysis of its priorities in war conditions, their features, expediency and justification. Methods. General scientific and special methods are used: analysis, synthesis, grouping, description, comparison, theoretical generalization and abstract-logical. Results. During the war, the issue of the effectiveness of the management of the country's financial resources becomes relevant. The analysis of the structure of budget expenditures demonstrates the priorities of the budget policy within the concentrated volume of financial resources, the possibilities of the state or local budgets for financing activities, the corresponding category of expenditures. In 2022, there were significant changes in budget policy priorities, caused by a full-scale Russian invasion and the need for a significant increase in funding for the security and defense sector. There was a problem with servicing the state debt and the impossibility of filling the revenue part of the state and local budgets to form the appropriate level of expenditures, which is a characteristic feature of a country whose economy is engulfed in war. The analysis of expenditures by types of budgets and the structure of the consolidated budget by functional classification shows that the priorities of the budget policy in peacetime and in the conditions of martial law are different. The hypothesis regarding the differentiation of the budget by military significance is put forward and substantiated. Conclusions. If before the war, the priorities of budget policy were the post-pandemic recovery of the economy and the direction of investments in the country's future, now - ensuring defense capability and stable functioning. Redirecting a significant amount of financial resources to the needs of the security and defense sector of Ukraine is an appropriate, justified and justified step. In the post-war period, the priorities of budget policy will change, based on those tasks and goals, which will be determined by medium- and long-term programs for the recovery and development of Ukraine. At the same time, the task of increasing the potential of the Armed Forces of Ukraine and the development of the military-industrial complex will continue to be a priority area of budget policy. In order to increase the effectiveness of budget policy and its effectiveness, it is necessary to reform outdated methods and approaches to managing budget expenditures, introduce full-fledged medium-term budget planning, constantly analyze the tasks and goals of budget programs, achieve the planned results, and on this basis develop proposals regarding the features of the further implementation of these programs in planned and subsequent budget periods.

지방자치단체 재정지출 영향요인 분석

This research seeks to investigate the existence of spatial autocorrelation within the expenditure framework of local governments in Korea, and to comparatively analyze the intensity of such autocorrelation across various expenditure categories. Addressing the limitations of previous studies, we have distinguished between national and local expenses in the budget of local governments, restricting our analysis exclusively to the local expenses. Our principal findings are as follows.&#x0D; Firstly, through the use of Moran I tests on cross-sectional data partitioned by expenditure categories, we have found evidence of spatial autocorrelation in the residuals for the majority of these categories. Secondly, both spatial lag and spatial error variables were found to be significant across all expenditure categories, with the intensity of spatial interactions of local government's own-sourced spending being the most notable in the realms of transportation and regional development. Lastly, population density and per capita local taxes were recognized as the leading factors augmenting welfare spending.

Analisis Penyerapan Anggaran Belanja Daerah Studi Kasus pada Biro Umum Sekretariat Daerah Provinsi Sulawesi Utara

The purpose of this study was to find out the mechanisms, constraints in absorbing the budget and efforts to maximize the absorption of the regional budget at the General Bureau of the Regional Secretariat of North Sulawesi Province. This type of research is qualitative research with a case study method. To obtain the necessary data, the authors carried out data collection activities by means of participatory observation, in-depth interviews, and documentation analysis. The results of the study show that the General Bureau has implemented a regional financial management mechanism based on regulations, although there are still some obstacles in its implementation. In addition, as the central unit, it has the function of managing the salaries of benefits for all civil servants who are included in the personnel expenditure category within the Regional Secretariat and has the functional duties of managing Regional Secretariat assets which are included in the capital expenditure category so that it has a fairly large portion of the total budget. However, the realization of the absorption of the budget for the General Bureau in the last 3 years has a sizeable difference between Semesters I and II. Although, the absorption rate is included in the category of moderate budget absorption realization above 90% up to 94.99%. Obstacles faced in absorbing the budget at the General Bureau, namely the urgency of activities and constraints from third parties, availability of budgets and leadership policies, organizational applications/systems and administrative files, human resources and organizational culture (slowback expenditure phenomenon). The efforts made in the absorption of the regional expenditure budget by the General Bureau, namely increasing HR competencies and core values, improving facilities/infrastructure, communication and coordination, supervision and leadership innovation.&#x0D;

Impact of mobile payment adoption on household expenditures and subjective well‐being

AbstractThis paper estimates the effects of mobile payment adoption on household expenditures and people's subjective well‐being. We consider four categories of household expenditures (that on clothes, durable goods, consumer goods, and cultural and leisure activities) and four indicators (life satisfaction, contentment, income satisfaction, and depression) of subjective well‐being. We use the Augmented Inverse Probability Weighting estimator to analyze the 2017 Chinese General Social Survey data while accounting for the selection bias inherent in mobile payment adoption. The empirical results show that people's decisions to adopt mobile payment are positively associated with their educational levels, car ownership, social interaction, internet penetration rate, and residential location. Mobile payment adoption significantly increases household expenditures on consumer goods and cultural and leisure activities but not on expenditures on clothes and durable goods. Moreover, mobile payment adoption significantly decreases people's contentment while increasing depression. We also find that mobile payment adoption significantly decreases the contentment of urban people but significantly increases the depression of rural people.

Summer Olympic sports and female athletes: comparison of anti-doping collections and prohibited substances detected in Australia and New Zealand vs. France.

Like any athlete, female athletes may be tempted to use prohibited substances during competition or training to enhance their performance. Anti-doping tests performed on female athletes in summer Olympic sports from two geographical areas: Australia/ New Zealand, and France were compared. First, the distribution of sample collections across different sports disciplines, as well as the distribution of substances was investigated. Then the distribution of collections and substances detected in the five sports categories (Strength/Speed, Endurance, Mixed, Motor Skills with High Energy Expenditure, and Motor Skills with Low Energy Expenditure) were studied with consideration of therapeutic use exemptions obtained by the athlete. Australia/New Zealand and France were similar in their overall number of anti-doping collections performed. Likewise, both regions had the same sports disciplines (athletics, aquatics, cycling) and sport categories (Mixed and Endurance) as having the highest number of sample collections. The Motor Skills with High Energy Expenditure, and Motor Skills with Low Energy Expenditure categories had the lowest number of sample collections. However, the number of substances detected was significantly different (p < 0.05) with a greater number of substances found in the French data. There were a few substances in common between the two geographical areas, namely prednisone/prednisolone, carboxy-THC, terbutaline, vilanterol and methylphenidate, but most were different. In-competition tests were the category where most of the AAFs were found.

The economic burden experienced by carers of children who had a critical deterioration at a tertiary children’s hospital in the United Kingdom (the DETECT study): an online survey

BackgroundUnplanned critical care admissions following in-hospital deterioration in children are expected to impose a significant burden for carers across a number of dimensions. One dimension relates to the financial and economic impact associated with the admission, from both direct out-of-pocket expenditures, as well as indirect costs, reflecting productivity losses. A robust assessment of these costs is key to understand the wider impact of interventions aiming to reduce in-patient deterioration. This work aims to determine the economic burden imposed on carers caring for hospitalised children that experience critical deterioration events.MethodsDescriptive study with quantitative approach. Carers responded to an online survey between July 2020 and April 2021. The survey was developed by the research team and piloted before use. The sample comprised 71 carers of children admitted to a critical care unit following in-patient deterioration, at a tertiary children’s hospital in the UK. The survey provides a characterisation of the carer’s household and estimates of direct non-medical costs grouped in five different expenditure categories. Productivity losses can also be estimated based on the reported information.ResultsMost carers reported expenditures associated to the child’s admission in the week preceding the survey completion. Two-thirds of working carers had missed at least one workday in the week prior to the survey completion. Moreover, eight in ten carers reported having had to travel from home to the hospital at least once a week. These expenditures, on average, amount to £164 per week, grouped in five categories (38% each to travelling costs and to food and drink costs, with accommodation, childcare, and parking representing 12%, 7% and 5%, respectively). Additionally, weekly productivity losses for working carers are estimated at £195.ConclusionUnplanned critical care admissions for children impose a substantial financial burden for carers. Moreover, productivity losses imply a subsequent cost to society. Even though subsidised hospital parking and on-site accommodation at the hospital contribute to minimising such expenditure, the overall impact for carers remains high. Interventions aiming at reducing emergency critical care admissions, or their length, can be crucial to further contribute to the reduction of this burden.Trial RegistrationCurrent Controlled Trials ISRCTN61279068, date of registration 07/06/2019, retrospectively registered.