Cost Recovery Model Research Articles

The 59th Annual Meeting of the Society for Low Temperature Biology, 20-22 September 2023, Vigo, Spain

Involving patients and their tissues in the research pathway is crucial for future heath innovations. There are many challenges including sustainability, logistical organisation whilst maintaining robust ethical oversight. For over a decade, TAPb has developed to become a research infrastructure to facilitate patient-centric studies across the research pipeline (from bench science, translation to human tissue and the sample component of interventional clinical trials). The TAPb platform groups researchers across academic, commercial and clinical trial sectors, and clinical services. This spreads the costs of the core team, and introduces capacity to provide specialised research services in an incremental way. TAPb is a not-for-profit, full cost recovery model that has been implemented across 7 patient clinical services within the Royal Free London NHS Foundation Trust. It supports an office of 6 fulltime staff, complemented by a number (currently about 7) part-time staff, to reflect the fluctuations in research demand. The researcher journey starts with TAPb linking NHS standard of care and research requirements to aid study design and feasibility. TAPb then provides suitable ethics and project management to develop timescales and delivery methodologies according to evolving research requirements, throughout the delivery phase. Samples and link-anonymised clinical data, and disease interpretation is provided to place samples in the correct research context. This presentation will provide an overview of the important steps which TAPb office have learnt which can make the infrastructure sustainable. Some examples of the significant research impact will be given as an illustration.

A perspective into full cost recovery within a core facility/shared resource lab.

Here we outline a vignette of the Bioscience Technology Facility (BTF) at the University of York as a singular exemplar of the Full Cost Recovery model. It is fully appreciated that every facility operates slightly differently, and each are subject to various rules at the institutional, regional and national level. Understanding the regulations that need to be followed for your cost recovery model may require discussion with your administrators to ensure compliance regulations for your Institution and governing bodies are followed. The below is almost a pick and mix of ways of working. It is, however, one of the few examples that is able to fully recover its operating costs within an academic environment and has sought and obtained full institutional and funders support. This model is now being much more widely adopted across the United Kingdom although again always with slightly different interpretations.

Questioning Day Zero: Rights, Provision, and Water Inequality in South Africa

The City of Cape Town experienced one of its worst droughts in 2015–2018, resulting in the Cape Water Crisis. This crisis revealed existing and new inequalities in how the city distributed water. I conducted fieldwork in the township of Khayelitsha in Cape Town, South Africa, against the backdrop of the crisis, to investigate how the city’s response to the drought worsened water inequality in informal settlements. Geography and poor water governance negatively affected water service delivery within the city, and townships as contested spaces faced the greatest inequality. I analyzed the city’s water management policy and strategies, conducted in-depth interviews with service providers who dealt directly with water distribution in Khayelitsha, and interviewed residents in different settlements of the township. As water inequality is relative, the study required a comparative basis to make the argument of unequal distribution using John Rawls’ theory of distributive justice. Literature at the time, in general, looked at inequality across different and distant settlements, with comparisons between the township as a monolith and the central business district and suburbs. I focused on inequality by studying two settlements within the same township. Although water inequality was caused by spatial inequality, it is upheld by a host of sociopolitical factors. The South African Constitution may enshrine water as a basic human right, but experiences from Khayelitsha reveal a cost-recovery model for water service delivery that prioritizes paying customers and disregards the poor.

Research on the Guidance Mechanism for the Price Signal of Power Grid Connection Service

At present, the utilization hours of thermal power continue to decline, and renewable energy generation also has a serious socket phenomenon, so it is necessary to guide the construction of power side selection points through price signals, so as to promote the smooth integration of more power generation into the grid. This study focuses on the connection services provided by grid enterprises to power side and demand side, analyzes and summarizes the connection charging practices of different countries, designs a shallow connection cost recovery model according to energy strategy and the characteristics of supply and demand side in our country, and puts forward feasible suggestions for renewable energy generation connection charging, in order to promote the investment and construction of grid and the consumption of renewable energy.

Willingness to pay for cataract surgery and associated factors among cataract patients in Outreach Site, North West Ethiopia.

In Ethiopia, cataract surgery is mainly provided by donors free of charge through outreach programs. Assessing willingness to pay for patients for cataract surgery will help explain how the service is valued by the beneficiaries and design a domestic source of finance to sustain a program. Although knowledge concerning willingness to pay for cataract surgery is substantive for developing a cost-recovery model, the existed knowledge is limited and not well-addressed. Therefore, the study aimed to assess willingness to pay for cataract surgery and associated factors among cataract patients in Outreach Site, North West Ethiopia. A cross-sectional outreach-based study was conducted on 827 cataract patients selected through a simple random sampling method in Tebebe Gion Specialized Hospital, North West Ethiopia, from 10/11/2018 to 14/11/2018. The data were collected using a contingent valuation elicitation approach to elicit the participants' maximum willingness to pay through face to face questionnaire interviews. The descriptive data were organized and presented using summary statistics, frequency distribution tables, and figures accordingly. Factors assumed to be associate with a willingness to pay were identified using a Tobit regression model with a p-value of <0.05 and confidence interval (CI ≠ 0). The study involved 827 cataract patients, and their median age was 65years. About 55% of the participants were willing to pay for the surgery. The average amount of money willing to pay was 17.5USD (95% CI; 10.5, 35.00) and It was significantly associated with being still worker (β = 26.66, 95% CI: 13.03, 40.29), being educated (β = 29.16, 95% CI: 2.35, 55.97), free from ocular morbidity (β = 28.48, 95% CI: 1.08, 55.90), duration with the condition, (β = -1.69, 95% CI: -3.32, -0.07), admission laterality (β = 21.21, 95% CI: 3.65, 38.77) and remained visual ability (β = -0.29, 95% CI (-0.55, -0.04). Participants' willingness to pay for cataract surgery in outreach Sites is much lower than the surgery's actual cost. Early intervention and developing a cost-recovery model with multi-tiered packages attributed to the neediest people as in retired, less educated, severely disabled is strategic to increase the demand for service uptake and service accessibility.

Developing a methodology to recover the cost of wastewater reuse: A proposal based on the polluter pays principle

In this study, we propose a cost recovery model for a wastewater treatment and reuse process based on the polluter pays principle that, among other things, provides appropriate incentives for efficient waster use and guarantees its future availability. Finally, the proposed cost recovery model is then applied using date provided by the Wastewater Treatment Plant of Santa Cruz de Tenerife (Canary Island, Spain). Using the tariff system proposed in this article for wastewater reuse, citizens would become aware of the financial investments involved in this process with the consequent impact on saving water, which would then help maintain reserves.

Bioinformatics Core Survey Highlights the Challenges Facing Data Analysis Facilities.

Over the last decade, the cost of -omics data creation has decreased 10-fold, whereas the need for analytical support for those data has increased exponentially. Consequently, bioinformaticians face a second wave of challenges: novel applications of existing approaches (e.g., single-cell RNA sequencing), integration of -omics data sets of differing size and scale (e.g., spatial transcriptomics), as well as novel computational and statistical methods, all of which require more sophisticated pipelines and data management. Nonetheless, bioinformatics cores are often asked to operate under primarily a cost-recovery model, with limited institutional support. Seeing the need to assess bioinformatics core operations, the Association of Biomolecular Resource Facilities Genomics Bioinformatics Research Group conducted a survey to answer questions about staffing, services, financial models, and challenges to better understand the challenges bioinformatics core facilities are currently faced with and will need to address going forward. Of the respondent groups, we chose to focus on the survey data from smaller cores, which made up the majority. Although all cores indicated similar challenges in terms of changing technologies and analysis needs, small cores tended to have the added challenge of funding their operations largely through cost-recovery models with heavy administrative burdens.

Next Chapter of the Taiwan Biobank: Sustainability and Perspectives

The emergence of biobanks has expanded the scope of biomedical research, ushering in an era of "precision medicine" to improve the treatment of disease. However, biobanks also face sustainability challenges comprising three dimensions-"financial," "operational," and "social." The Taiwan Biobank (TWB), as a large-scale national biobank that supplies valuable phenotypic and genetic information to biomedical researchers on an application basis to investigate the relationship among personal health, genes, lifestyle, environment and diseases of the Taiwanese population, has not been sufficiently explored by researchers. Although the TWB has successfully reached a few milestones since its inception, it faces many sustainability challenges. For the next chapter of the TWB, we propose three strategies to improve sustainability. First, the Ministry of Health and Welfare launched the TWB as an infrastructure project under the leadership of Academia Sinica in 2012. We now believe that it is time that the TWB is transformed into a legal entity as a nondepartmental public body. This would not only ensure efficient, effective, and flexible operation, but would also facilitate cooperation with commercial entities. Second, we suggest that the TWB integrates with other Taiwanese biobanks to reduce cost, improve low utilization, and expand specimen collection. Third, self-financing is important if funding is ceased. Besides implementing a cost-recovery model, the commodities developed by the TWB (e.g., TWB 2.0 microarray) will help increase income. After each of these strategies has been discussed in detail, this article will conclude by highlighting how these practices can help improve biobank sustainability.

Implementing a Fee-for-Service Cervical Cancer Screening and Treatment Program in Cameroon: Challenges and Opportunities

Background: Cervical cancer screening is one of the most effective cancer prevention strategies, but most women in Africa have never been screened. In 2007, the Cameroon Baptist Convention Health Services, a large faith-based health care system in Cameroon, initiated the Women's Health Program (WHP) to address this disparity. Trained nurses provide fee-for-service cervical cancer screening using visual inspection with acetic acid enhanced by digital cervicography (VIA-DC), prioritizing care for women living with HIV/AIDS. They also provide clinical breast examination, family planning (FP) services, and treatment of reproductive tract infections (RTI) and refer for further tests and treatment indicated. Methods: We retrospectively reviewed and analyzed WHP medical records from women who presented for cervical cancer screening from 2007-2014. Results: In 8 years, WHP nurses screened 44,979 women for cervical cancer. The number of women screened increased nearly every year. The WHP is sustained primarily on fees-for-service, with external funding totaling about $20,000 annually. In 2014, of 12,191 women screened for cervical cancer, 99% received clinical breast exams, 19% received FP services, and 4.7% received treatment of RTIs. We document successes, challenges, solutions implemented, and recommendations for optimizing this screening model. Conclusion: The WHP's experience using a cost-recovery model and offering multiple services in a single clinic rather than stand-alone cervical cancer screening may be a practical model to make cervical cancer screening services accessible, comprehensive and sustainable. Integrating other women's health services enabled women to address additional health care needs.

Role of laser refractive surgery in cross-subsidization of nonprofit humanitarian eyecare and the burden of uncorrected refractive error in Nepal: Pilot project

To establish a refractive surgery unit at Tilganga Institute of Ophthalmology through support from international donations and provide knowledge transfer for doctors and management to make the unit self-sustaining, nonprofit laser refractive surgery, and financial support for other eyecare projects at Tilganga. Tilganga Institute of Ophthalmology, Kathmandu, Nepal. Retrospective study. A foundation was created to establish a refractive surgery unit using a cost-recovery model; that is, patients are charged according to their financial status to cover running costs, patients without funds to pay for surgery, and other eyecare projects for the underprivileged population of Kathmandu, Nepal. Donations were obtained to fund refurbishment within Tilganga Hospital and purchase equipment and technology. A Nepalese surgeon was selected from Tilganga and completed an 8-month fellowship and proctorship of the first series of surgeries. The refractive surgery unit was opened in January 2012, and the cost-recovery model was evaluated up to December2016. During the period evaluated, 74.8% of patients were treated at full cost, 17.2% at subsidized cost, and 8.6% free of charge. The refractive surgery unit generated a profit representing 28% of the running cost in this period, which was used to reduce the deficit of the main hospital. Surgical outcomes achieved were comparable to those reported by groups in the developed world. A self-sustaining nonprofit laser refractive surgery clinic, operating with high quality, was successfully implemented supported by international donations for initial setup costs and a cost-recovery model thereafter.

Assessing the productivity and profitability of the Solar Market Garden

Successful scale-up of any development project requires a deep understanding of the real-world economics of the intervention, and compelling evidence that such an investment would be worthwhile. This cost-benefit estimate is typically assessed in two ways: (a) by comparing the coefficient of impact along some margin measured in an impact evaluation (βˆ) to the unit implementation cost of the project, and/or (b) by conducting adoption studies, where autonomous adoption is assumed to indicate that the adopter has deemed the investment worthwhile (i.e., financially sustainable). However, these two techniques can be particularly difficult for development engineering projects that are large at the unit scale (or are group-based) and for projects that may have impacts on many margins or outcomes at once. Here we present the framework for, and analysis from, a field monitoring campaign in the interim evaluation period for community-scale solar-powered irrigation systems (Solar Market Gardens, or SMGs) in northeast Benin, West Africa. We used this interim monitoring to directly construct a CBA, and to document the pathways of impact actually at play for a project hypothesized ex-ante to have potential economic, food security, and gender impacts. We monitored all garden activity a the individual and group level for most of the dry season, including total production, sales, home consumption, input use, marketing, and labor (a key factor often overlooked when considering the cost of agricultural development projects). By combining production and sales data with cost information, we show that the most productive agricultural groups using the system only in the dry season would be profitable in a full cost-recovery model with no economies of scale, but that lower performing groups would not; we also show that many plausible scale-up models and financing mechanisms would be profitable. We then show how this type of monitoring can complement impact evaluation by elucidating different pathways of impact that could be used to understand heterogeneity in outcomes among beneficiaries. We document variance both within and between groups across numerous potential pathways of impact for the SMG; the heterogeneity in intraclass correlation coefficients (ICCs) across these indicators highlights the importance of understanding the causal chain(s), especially for cross-sectoral development engineering projects like the SMG. We conclude by discussing how this monitoring effort fits into the larger evaluation of the SMG, and how such data have been used to both adaptively refine the project, improving the likelihood for successful scale-up.

New models for open digital collections?

This article discusses the potential for new community-based funding models to support digitization and open access (OA) publishing of digital collections. Digital collections of archival material such as texts, images and moving images are an important complement to journals and books in the ecosystem of scholarly resources that researchers, teachers and learners use. However, institutions find them expensive to acquire from publishers or to digitize themselves. In the US, Reveal Digital (RD) has set up a ‘library crowdfunding’ programme based on a cost-recovery OA model. The article describes how Jisc has collaborated with RD to introduce the model to UK institutions through their ‘Independent Voices’ collection of 20 th -century alternative press materials and, in doing so, explores the potential and challenges for developing a similar approach in the UK.

2050

OBJECTIVES/SPECIFIC AIMS: To improve the quality of evidence synthesis projects, including systematic reviews and other comparative effectiveness reviews, at the University of Utah. METHODS/STUDY POPULATION: Systematic reviews and other types of evidence syntheses are best when collaborative teams with expertise in multiple disciplines participate, including content experts, librarians and information specialists, systematic review methodologists, and statisticians. The Center for Clinical &amp; Translational Science (CCTS), due to its interdisciplinary nature, connectivity to clinical experts, and existing Cores of methodologists, presented an opportune location for a Systematic Review Core. We designed the Systematic Review Core to focus on 2 primary aspects of evidence synthesis support: overall systematic review methodology guidance and in-depth information retrieval planning and execution. After establishing a conceptual partnership, a new position, Evidence Retrieval and Synthesis Librarian, was created to build capacity within the Core. RESULTS/ANTICIPATED RESULTS: Close connections with the CCTS’s Population Health Research Foundation have led to better interdisciplinary coverage of systematic reviews and other evidence syntheses produced by the University of Utah. We are able to partner with statisticians and clinical experts from formulating the question to completing the final manuscript. Hourly rates charged through a cost recovery model have enabled us to grow our staff able to work on the Core, as well as offset costs for major databases and resources these bibliographic data-heavy research methods require. After 1 year of existence, the Core is already at maximum capacity, with no sign of slowing. Projects have ranged from brief consultations to highly intense interactions for the duration of the research spectrum. We have also been added as key personnel to grants with systematic review components. DISCUSSION/SIGNIFICANCE OF IMPACT: Systematic reviews and other evidence syntheses are a labor-intense, interdisciplinary team effort that fit well within the scope of CTSA’s. They are a key component of the translation of science to practice, and can be used at all stages of the translational science spectrum. Quality of systematic reviews remains poor, particularly surrounding protocol development, sensitive search strategy design and reporting, and overall reporting. Librarians and information specialist involvement has been shown to positively correlate to the search strategy design and reporting aspects of systematic reviews, and librarians and information specialists increasingly act as systematic review methodologists. By including librarians and information specialists as part of the CTSA’s official Core structure, these systematic review methodologists are able to connect with statisticians, other methodologists, and clinical experts in a nexus of interdisciplinarity. At the University of Utah, the visibility and structure provided by the CCTS helps the Systematic Review Core with promotion, creating connections and opportunities for collaboration across the campus. This partnership has already led to increased uptake in services, and over time, we believe it will increase the quality of the science produced. CTSA’s have a natural partner with their health science library colleagues in translational science, as shown by this model.

"There is no free here, you have to pay": actual and perceived costs as barriers to intermittent preventive treatment of malaria in pregnancy in Mali.

Background“There is no free here,” the words of a Malian husband, illustrate how perceptions of cost can deter uptake of intermittent preventive treatment of malaria in pregnancy (IPTp). The Malian Ministry of Health (MOH) recommends a minimum of three doses of IPTp at monthly intervals. However, despite a national policy that IPTp be provided free of charge, only 35 % of pregnant women receive at least one dose and less than 20 % receive two or more doses.MethodsThis study explored perceptions and experiences of IPTp cost in Mali and their impact on uptake, using qualitative interviews and focus groups with pregnant women, husbands and mothers-in-law. Study team members also interviewed and observed health workers at four health centres, two in Sikasso Region and two in Koulikoro.ResultsDespite national-level policies, actual IPTp costs varied widely at study sites—between facilities, and visits. Pregnant women may pay for IPTp, receive it free, or both at different times. Health centres often charge a lump sum for antenatal care (ANC) visits that includes both free and fee-based drugs and services. This makes it difficult for women and families to distinguish between free services and those requiring payment. As a result, some forego free care that, because it is bundled with other fee-based services and medications, appears not to be free. Varying costs also complicate household budgeting for health care, particularly as women often rely on their husbands for money. Finally, while health facilities operating under the cost-recovery model strive to provide free IPTp, their own financial constraints often make this impossible.ConclusionsBoth actual and perceived costs are currently barriers to IPTp uptake. Given the confusion around cost of services in the two study regions, more detailed national-level studies of both perceived and actual costs could help inform policy and programme decisions promoting IPTp. These studies should evaluate both quantitatively and qualitatively the cost information provided to and understood by pregnant women and their families. Meanwhile, unbundling free and fee-based services, making clear that IPTp is free, and ensuring that it is provided at no cost could help increase uptake. Free community-based distribution might be another route to increased uptake and adherence.

Establishing and funding a digital asset management system at the University of Chicago

In 2010, the University Communications Department at the University of Chicago began investigating the building of a digital asset management (DAM) system with the potential for university-wide reach. This case study discusses the evolution of this project from the fact-finding first steps to the current state of the DAM system, which was launched in February 2013. The DAM system was set up in University Communications with seed funding for one year, with a mandate to cover its own expenses after the first year. Therefore, in addition to establishing a DAM technological solution, the team developed a cost recovery model that fit the budgets of client departments and helped contribute to the system operations, ultimately creating a sustainable internal service called PhotoStore. The workflows, technology, standards and cost plans have been set up with a solid foundation so that the PhotoStore staff can continually process incoming images and add new users efficiently. This paper will discuss the major components of the PhotoStore service, how the service was established, lessons learned and plans for the future.

Reorganizing the General Clinical Research Center to improve the clinical and translational research enterprise.

In 2010, Virginia Commonwealth University (VCU) was granted a Clinical and Translational Science Award which prompted reorganization and expansion of their clinical research infrastructure. A case study approach is used to describe the implementation of a business and cost recovery model for clinical and translational research and the transformation of VCU's General Clinical Research Center and Clinical Trials Office to a combined Clinical Research Services entity. We outline the use of a Plan, Do, Study, Act cycle that facilitated a thoughtful transition process, which included the identification of required changes and cost recovery processes for implementation. Through this process, the VCU Center for Clinical and Translational Research improved efficiency, increased revenue recovered, reduced costs, and brought a high level of fiscal responsibility through financial reporting.

Economic Operation Assessment of Micro-Grid Combining Photovoltaic and Energy-Storage

In order to carry an economic analysis of micro-grid project represented by photovoltaic power-generation, this paper proposed a cost recovery model for micro-grid project through case studies. Meanwhile, based on how micro-grid participates in market competition, we have designed the framework for gaining profits. Issues like basic profits, reasonable depreciation method and the project’s financial profitability are analyzed in detail.

No-Fault Peer Review Charges: The Price of Selectivity Need Not Be Access Denied or Delayed

Plans by universities and research funders to pay the costs of Open Access Publishing (Gold OA) are premature. Funds are short; 80% of journals (including virtually all the top journals) are still subscription-based, tying up the potential funds to pay for Gold OA; the asking price for Gold OA is still high; and there is concern that paying to publish may inflate acceptance rates and lower quality standards. What is needed now is for universities and funders to mandate OA self-archiving (of authors' final peer-reviewed drafts, immediately upon acceptance for publication) (Green OA). That will provide immediate OA; and if and when universal Green OA should go on to make subscriptions unsustainable (because users are satisfied with just the Green OA versions) that will in turn induce journals to cut costs (print edition, online edition, access-provision, archiving), downsize to just providing the service of peer review, and convert to the Gold OA cost-recovery model; meanwhile, the subscription cancellations will have released the funds to pay these residual service costs. The natural way to charge for the service of peer review then will be on a no-fault basis, with the author's institution or funder paying for each round of refereeing, regardless of outcome (acceptance, revision/re-refereeing, or rejection). This will minimize cost while protecting against inflated acceptance rates and decline in quality standards.

ICANN's 'Go/No-Go' Decision Concerning New gTLDs

The Internet Corporation for Assigned Names and Numbers (ICANN) should institute a variety of changes to its soon-to-be-issued Draft Applicant Guidebook for new generic Top Level Domains (gTLDs), which has sparked fierce and almost universal opposition from the global business community in its currently proposed implementation. The following recommendations should be addressed by ICANN prior to the release of its Draft Applicant Guide Book: * Elimination of the proposed 5% global domain name tax: ICANN's ill-conceived and potentially illegal tax bears no correlation to cost recovery model, is not limited to name registration fees, and contains provisions to prevent double taxation. * Creation of a Rebuttable Reserve Names List and an Expedited Domain Suspension Policy: Narrowly tailored to protect brand holders while respecting fair use rights, these mechanisms would minimize the need for expensive defensive domain name registration. * Creation of a Uniform Proxy Registration Policy: Baseline practices and safeguards should be established for proxy registration to prevent abuse that could harm legitimate users. * Creation of Registrant-Verified TLDs: Verifying the identity of registrants in certain TLDs would ensure accuracy of domain registration data and could minimize the need for defensive registrations.

Introduction of User Fees

One of the priorities of the Bangladesh Health and Family Planning Programme is to focus on a cost recovery policy by the introduction of user fees to improve quality and financial sustainability. To assist the policy we propose an operations research-based cost recovery model to find the best ‘service mix’ from outdoor, indoor, emergency and diagnostic services for sub-district-level health facilities. The model considers budget, patient flow patterns, resource availability, service demand and equity principal constraints. The study offers proposals to assist the decision-making process for the introduction of a user fee and considers how much to charge, which services to start with, and which to include later.