Decline In Expenditure Research Articles

Does outpatient mutual-aid reduce oncology patients' utilization of inpatient services?-An empirical study of outpatient mutual-aid policy in Wuhan, China.

The escalating costs of healthcare had prompted countries to undertake reforms, and in recent years China had focused on overhauling its outpatient healthcare system. China implemented the outpatient mutual-aid policy which had led to a change in the costs associated with outpatient treatment from being fully self-paid by the patient to being partially self-paid. This study aimed to assess the impact of the outpatient mutual-aid policy on inpatient services for oncology patients in Wuhan, China, exploring the impact that the cumbersome administration of health insurance would have on patient welfare. 24,260 oncology patients of the health insurance reimbursement database in Wuhan spanning from January 2022 to July 2023 were included. After data processing, 12,985 patients were included in the control group and 11,275 patients were included in the experimental group. The regression discontinuity design was employed to assess the impact of the policy. The findings was that the implementation of the outpatient mutual-aid would result in a reduction of 1.2days in the length of stay for oncology patients, a decrease in hospital costs by 5%, and a decline in expenditure of the health insurance reimbursement funds by 5 per cent. Incorporating outpatient costs into reimbursement supplanted the utilization of inpatient services, enhanced the allocation of healthcare resources, and alleviated the financial burden on oncology patients. Furthermore, it highlighted the detrimental impact of eligibility review to verify that a patient meets the reimbursement requirements of the health insurance policy on patient welfare.

The Impact of Teacher Unions on School District Finance and Student Achievement: Evidence From the Great Recession

I examine whether the impact of the Great Recession on school district spending, the allocation of resources, and student achievement varied depending on the strength of state’s teachers’ unions. Employing a diff-in-diff-in-diff identification strategy, I find that school districts in states with strong teachers’ unions experienced significantly larger declines in per-pupil expenditures during the economic downtown compared with otherwise similar districts in states with weak teachers’ unions. The larger decline in expenditures in strong union states, however, did not lead to a differential decline in student achievement relative to weak union states.

Associations between Health Education and Mental Health, Burnout, and Work Engagement by Application of Audiovisual Stimulation

Due to the COVID-19 pandemic, health education programs and workplace health promotion (WHP) could only be offered under difficult conditions, if at all. In Germany for example, mandatory lockdowns, working from home, and physical distancing have led to a sharp decline in expenditure on prevention and health promotion from 2019 to 2020. At the same time, the pandemic has negatively affected many people’s mental health. Therefore, our goal was to examine audiovisual stimulation as a possible measure in the context of WHP, because its usage is contact-free, time flexible, and offers, additionally, voice-guided health education programs. In an online survey following a cross-sectional single case study design with 393 study participants, we examined the associations between audiovisual stimulation and mental health, work engagement, and burnout. Using multiple regression analyses, we could identify positive associations between audiovisual stimulation and mental health, burnout, and work engagement. However, longitudinal data are needed to further investigate causal mechanisms between mental health and the use of audiovisual stimulation. Nevertheless, especially with regard to the pandemic, audiovisual stimulation may represent a promising measure for improving mental health at the workplace.

Re-visiting car guarding as a livelihood in the informal sector

ABSTRACT This study aims to examine how car guarding remains a sustainable means of livelihood in the informal sector. The study interviewed 30 car guards at six different locations in Durban, South Africa. It examined their demographic characteristics, income, education and skills, among other factors. Furthermore, it compares the findings from 2019 with the 2015 findings from Foster and Chasomeris (2017, Examining car guarding as a livelihood in the informal sector. Local Economy 32(6), 525–538. https://doi.org/10.1177/0269094217727990). The findings show deterioration in the real income levels and livelihoods. In 2015, 22 car guards earned above a domestic worker’s minimum hourly wage of ZAR15, compared to 16 car guards in 2019 and, only eight above the national minimum wage of ZAR20 per hour. There is a notable decline in expenditure on accommodation and reduced optimism about their future. Car guards still display a level of entrepreneurship, especially where daily bay fees are not paid to car guarding agents.

Techno-economic viability of on grid micro-hybrid PV/wind/Gen system for an educational building in Iran

In this research, a highly potential campus site for solar/wind energy production is identified with the purpose of micro-hybrid system installation in on-grid mode to sellback the excess electricity and hence economize the building as a source of income. A PV/wind/grid and PV/wind/grid/gen system are surveyed techno-economic wise. For case1, the net present cost (NPC) equals to $49,022, renewable fraction (RF) of 85.5%, and cost of energy (COE) $0.0024 is achieved at an inflation rate of 10% and wind speed of 6.8 m/s. While for the best feasible design of case2 (case2d), the NPC = $224,430, COE = $0.0272, RF = 63.6% are obtained. The results indicated that for a low inflation rate a simple PV/grid is appropriate and with the increase of inflation, more equipment incorporation to the system is a preferable choice. Increasing the number of wind turbine cause NPC reduction and the wind speed increase leads to COE reduction. The results indicated that the case1 with 10 XL10R and 76.0 kW generator capacity could generate 315000 kWh electricity which means 69.2% expenditure decline compared to when one turbine is used (maximum annual electricity production and minimum NPC). Increment of inflation rate from 10% to 15% at $0.35 biodiesel price, increases the RF from 14% to about 50%. This implies that when the fuel price is low together with the high inflation rate, the renewability of the system is more significant.

Local Public Finance Dynamics and Hurricane Shocks

Since 1980, over 2,000 local governments in US Atlantic and Gulf states have been hit by a hurricane. Such natural disasters can exert severe budgetary pressure on local governments’ ability to provide critical infrastructure, goods, and services. We study local government revenue, expenditure, and borrowing dynamics in the aftermath of hurricanes. These shocks impact, both, current local public resources through reducing tax revenues and expenditures, as well as future local public resources through increasing the cost of debt. Major hurricanes have much larger effects than minor hurricanes: major storms cause local revenues to fall by 6 to 7%. These losses persist at least ten years after a hurricane strike, leading to a 6% decline in expenditures on important public goods and services and a significant increase in the risk of default on municipal debt. Our results reveal how hurricanes can create a “vicious cycle” for local governments by increasing the cost of debt at critical moments after a hurricane strike, when localities are in greatest need of funding sources. Cities deemed riskier by ratings agencies face higher borrowing costs and thereby face constraints to invest in climate change adaptation. Municipalities with a racial minority composition 1 standard deviation above the sample mean suffer expenditure losses more than 2 times larger and debt default risk 8 times larger than municipalities with average racial composition in the decade following a hurricane strike. These results suggest that climate change can exacerbate environmental justice challenges.

Pricing of First and Second Generation Tyrosine Kinase Inhibitors (TKIs) Pre- and Post-Transition of Imatinib to Generic Status

Background: At its introduction in 2001, the list price of imatinib was $26,400/y; in February 2016, just prior to the transition to the generic status, the list price had risen to $120,000/y. While a transition to generic status was projected to reduce the list price, the magnitude and rate of decline in a real-world setting remains unknown. Further, the pricing patterns of 2nd generation TKIs (dasatinib and nilotinib) pre- to post- imatinib generic transition are not known. We address these gaps in this report. Methods: Truven Health MarketScan Database was used to determine the monthly drug expenditures for 1155 patients with CML diagnoses between 9/1/2014 and 11/30/2017 and receiving imatinib, nilotinib, or dasatinib as single agents. Patients were either commercially insured (n=977) or insured by Medicaid (n=178); median age at diagnosis was 50y; 54% were males. Expenditure for 30-day blocks/patient for imatinib, dasatinib, or nilotinib was calculated and pricing was adjusted via consumer price index for medical services in 2017. A single interrupted time series (ITS) method evaluated imatinib monthly expenditures for the health plan from 9/1/2014 to 11/30/2017, with imatinib switching to generic at 2/1/2016 as the "interruption". The initial six-month period post-interruption was excluded to allow for the new price structure to stabilize, resulting in a post-interruption period of observation from 8/1/2016 to 11/30/2017 (generic phase). Nilotinib and dasatinib were evaluated using a comparative ITS design. Results: Pre-generic vs. generic imatinib: As shown in Figures 1A and 1B, there was a significant (p<0.001) pre-generic increase in expenditure (commercial insurance: $173/patient/month, p<0.001; Medicaid: $199/patient/month, p=0.001). Controlling for secular trends, there was a statistically significant (p<0.001) reduction over the 6-month interruption (2/2016-8/2016: between the pre-generic and generic phase: commercial: $2,255/patient; Medicaid: $2,125/patient). This was followed by a continued small decline in expenditure during the generic phase (commercial, -$60/month/patient; p=0.04; Medicaid: -$203/month/patient; p=0.001). The annual health plan expenditure for imatinib during 2017 was estimated at $116,324. Difference-in-difference of slopes from pre-generic to generic phase (imatinib vs. nilotinib; imatinib vs. dasatinib): As shown in Figures 1A and 1B, the monthly per patient expenditures associated with both nilotinib and dasatinib maintained an increasing trend in both the pre-generic and generic phase of imatinib, resulting in a significant difference-in-difference slope for both commercially-insured patients (nilotinib: $-211, p=0.002; dasatinib: $-192, p=0.003) and Medicaid patients (nilotinib: $-350, p=0.002; dasatinib: $-243, p<0.001). This indicates that nilotinib and dasatinib had a greater magnitude of increase in expenditure from 2014 to 2017 than the decline in expenditure for imatinib for the same time period. Conclusion: After the switch to generic, the monthly expenditure for imatinib declined; the decline was steeper for Medicaid patients than commercially-insured patients. Although the proportions of patients receiving brand name versus generic imatinib are not known, the percent change in Imatinib expenditure over the time period analyzed was modest. Nilotinib and dasatinib health plan expenditure demonstrated a continued increase over time. Disclosures No relevant conflicts of interest to declare.

When Rebels Attack: Quantifying the Impacts of Capturing Territory from the Government in Yemen

Abstract Households were adversely affected by the mostly nonviolent capture of Yemen’s capital in 2014. Although socioeconomically advantaged households were initially better able to cope with the shock than other households, the capture resulted in a decline in expenditure for the entire population within three months. Struggling households turned to several coping strategies—they increasingly made purchases on credit, increased their reliance on self-employment to deal with a decline in the economic climate, and reduced both the quantity and quality of foods consumed. Furthermore, there was evidence of a loss of autonomy for women, where women were less likely to oversee food purchases and more likely to be in the household during the survey interview. These results demonstrate that the capture of territory without widespread violence can result in a decline in standards of living and further illustrate the manners in which households were able to cope with the shock.

Is there a retirement consumption puzzle in Japan? Evidence from a household panel dataset spanning several years

ABSTRACTUsing a unique long-run panel of Japanese households, this paper examines the changes in consumption at retirement (‘the retirement-consumption puzzle’). Our analysis shows that households’ expenditure does decline after the retirement of the household head and that changes in household composition at retirement cannot fully account for this decline. Changes in life-style/preferences after retirement also do not appear to explain a salient feature of the expenditure decline, namely, the strong correlation between the magnitudes of the expenditure decline and the income decline upon retirement. On the other hand, our finding that the expenditure decline is larger for households with smaller savings and/or that experienced a large unexpected income decline is broadly consistent with the standard LC/PIH augmented with unexpected shocks, while it does not rule out the possibility that there is a relatively small subset of households that are myopic and lack sufficient saving discipline.

The US oil supply revolution and the global economy

This paper investigates the global macroeconomic consequences of falling oil prices due to the oil revolution in the USA, using a global VAR model estimated for 38 countries/regions over the period 1979Q2–2011Q2. Set identification of the US oil supply shock is achieved through imposing dynamic sign restrictions on the impulse responses of the model. The results show that there are considerable heterogeneities in the responses of different countries to a US supply-driven oil price shock, with real GDP increasing in both advanced and emerging market oil-importing economies, output declining in commodity exporters, inflation falling in most countries, and equity prices rising worldwide. Overall, our results suggest that a US supply-driven oil price shock (equivalent to a 10–12% fall per quarter in the price of oil) results in an increase in global growth by 0.16–0.37 percentage points in the medium term. This is mainly due to an increase in spending by oil-importing countries, which exceeds the decline in expenditure by oil exporters.

The Execution of the Federal Budget for H1 2017: Further Consolidation

As demonstrated by the period-end results of H1 2017, the dynamic displayed by the main parameters of the federal budget points to revenue growth by 1.8 p.p. of GDP and expenditure decline by 0.8 p.p. of GDP relative to the corresponding period of the previous year. The upshot has been a shrinkage of the budget deficit to 1.0% of GDP. The relatively robust growth rate of the revenue side of the consolidated budget of the RF subjects observed over H1 2017 triggered an accelerated growth rate of expenditure in the wealthier regions. At the same time, the poorer regions continued to economize by suppressing growth of their budget expenditure.

Inflation expectations, economic policy ambiguity and micro-level consumer behavior

Purpose This paper aims to augment existing literature by examining how specific macroeconomic conditions (economic policy uncertainty and inflation expectations) influence micro-level (instead of macro-level) behavioral dynamics exhibited by the average consumer. Design/methodology/approach This study conducted empirical analysis using structural vector autoregressive estimation technique. Findings The average consumer tends to exhibit significantly varied micro-level expenditure behavioral patterns not readily observed at the macro- or aggregate-level expenditures. For instance, this study finds that in the short run, inflation expectations tend to have a significant positive impact on both non-durable goods and service expenditures; the same condition, however, tends to have a negative impact on durable goods. Additionally, this study also finds that economic policy uncertainty, unlike inflation expectations, tends to constrain consumption expenditures at all micro levels with very significant variations in decline in expenditures made. Originality/value Unlike legion of empirical work based on macro-level analysis, this study adopts a micro-level analysis and also engages two macroeconomic conditions (inflation expectations and economic policy uncertainty) not already examined in existing studies.

The US Oil Supply Revolution and the Global Economy

This paper investigates the global macroeconomic consequences of falling oil prices due to the oil revolution in the United States, using a Global VAR model estimated for 38 countries/regions over the period 1979Q2 to 2011Q2. Set-identification of the U.S. oil supply shock is achieved through imposing dynamic sign restrictions on the impulse responses of the model. The results show that there are considerable heterogeneities in the responses of different countries to a U.S. supply-driven oil price shock, with real GDP increasing in both advanced and emerging market oil-importing economies, output declining in commodity exporters, inflation falling in most countries, and equity prices rising worldwide. Overall, our results suggest that following the U.S. oil revolution, with oil prices falling by 51 percent in the first year, global growth increases by 0.16 to 0.37 percentage points. This is mainly due to an increase in spending by oil importing countries, which exceeds the decline in expenditure by oil exporters.

The U.S. Oil Supply Revolution and the Global Economy

This paper investigates the global macroeconomic consequences of falling oil prices due to the oil revolution in the United States, using a Global VAR model estimated for 38 countries/regions over the period 1979Q2 to 2011Q2. Set-identification of the U.S. oil supply shock is achieved through imposing dynamic sign restrictions on the impulse responses of the model. The results show that there are considerable heterogeneities in the responses of different countries to a U.S. supply-driven oil price shock, with real GDP increasing in both advanced and emerging market oil-importing economies, output declining in commodity exporters, inflation falling in most countries, and equity prices rising worldwide. Overall, our results suggest that following the U.S. oil revolution, with oil prices falling by 51 percent in the first year, global growth increases by 0.16 to 0.37 percentage points. This is mainly due to an increase in spending by oil importing countries, which exceeds the decline in expenditure by oil exporters.

The U.S. Oil Supply Revolution and the Global Economy

This paper investigates the global macroeconomic consequences of falling oil prices due to the oil revolution in the United States, using a Global VAR model estimated for 38 countries/regions over the period 1979Q2 to 2011Q2. Set-identification of the U.S. oil supply shock is achieved through imposing dynamic sign restrictions on the impulse responses of the model. The results show that there are considerable heterogeneities in the responses of different countries to a U.S. supply-driven oil price shock, with real GDP increasing in both advanced and emerging market oil-importing economies, output declining in commodity exporters, inflation falling in most countries, and equity prices rising worldwide. Overall, our results suggest that following the U.S. oil revolution, with oil prices falling by 51 percent in the first year, global growth increases by 0.16 to 0.37 percentage points. This is mainly due to an increase in spending by oil importing countries, which exceeds the decline in expenditure by oil exporters.

Can increases in CHIP copayments reduce program expenditures on prescription drugs?

The primary aim is to explore whether prescription drug expenditures by enrollees changed in Alabama's CHIP program, ALL Kids, after copayment increases in fiscal year 2004. The subsidiary aim is to explore whether non-pharmaceutical expenditures also changed. Data on ALL Kids enrollees between 1999-2007, obtained from claims files and the state's administrative database. We used data on children who were enrolled between one and three years both before and after the changes to the copayment schedule, and estimate regression models with individual-level fixed effects to control for time-invariant heterogeneity at the child level. This allows an accurate estimate of how program expenditures change for the same individual following copayment changes. Primary outcomes of interest are expenditures for prescription drugs by class and brand-name and generic versions. We estimate models for the likelihood of any use of prescription drugs and expenditure level conditional on use. Following the copayment increase, the probability of any expenditure decline by 5.8%, brand name drugs by 6.9%, generic drugs by 7.4%. Conditional on any use, program expenditures decline by 7.9% for all drugs, by 9.6% for brand name drugs, and 6.2% for generic drugs. The largest declines are for antihistamine drugs; the least declines are for Central Nervous System agents. Declines are smaller and statistically weaker for children with chronic health conditions. Concurrent declines are also seen for non-pharmaceutical medical expenditures. Copayment increases appear to reduce program expenditures on prescription drugs per enrollee and may be a useful tool for controlling program costs.

8 - “University is ISO 9000:2008 Certified”: Neoliberal Echoes, Knowledge Production and Quality Assurance in Kenyan State Universities

In Africa, Quality Assurance (QA) in universities has acquired a sense of urgency owing to the rapid growth of the university sector in the last two decades. The adoption of neoliberal tenets in the development of universities has witnessed the surge in student numbers and types of degree-granting institutions. The decline in budgetary support for higher education, evident in average per-student expenditure decline from US $6,300 to $1,500 by 1990, rising student enrolments coupled with inadequate and outdated teaching and learning resources, alongside massive staff exodus as well as poor governance have raised troubling questions about the quality of education provided. The rising concerns about the quality of the institutions and the graduates have catalyzed national educational authorities and individual institutions to institute quality assurance strategies in order to enhance the quality of education provide. This paper looks at how neoliberalism has undermined faculty validation of learning within the context of QA. Faculty exclusion in knowledge validation via QA is examined from the following themes: national accreditation, ISO certification, internal QA units, internships & attachments, and the deployment of information communication technologies. It is apparent that the development of universities along the neoliberal paradigm has eroded faculty prerogatives in QA as market ideals have triumphed over academic principles.

Food marketing expenditures aimed at youth: putting the numbers in context.

In response to concerns about childhood obesity, the Federal Trade Commission (FTC) released two reports documenting food and beverage marketing expenditures to children and adolescents. The recently released 2012 report found an inflation-adjusted 19.5% reduction in marketing expenditures targeted to youth from $2.1 billion in 2006 to $1.8 billion in 2009. The current article highlights features of the FTC's analysis, examines how expenditures relate to youth exposure to food marketing, and assesses changes in the nutritional content of marketed products. Of the $304.0 million decline in expenditures, $117.8 million (38.7%) was from a decline in premium (i.e., restaurant children's meal toys) expenditures rather than direct marketing. Although inflation-adjusted TV expenditures fell by 19.4%, children and teens still see 12-16 TV advertisements (ads)/day for products generally high in saturated fat, sugar, or sodium. In addition, newer digital forms of unhealthy food and beverage marketing to youths are increasing; the FTC reported an inflation-adjusted 50.7% increase in new media marketing expenditures. The self-regulatory Children's Food and Beverage Advertising Initiative (CFBAI) is limited in scope and effectiveness: expenditures increased for many noncovered marketing techniques (i.e., product placement, movie/video, cross-promotion licenses, athletic sponsorship, celebrity fees, events, philanthropy, and other); only two restaurants are members of CFBAI, and nonpremium restaurant marketing expenditures were up by $86.0 million (22.5% inflation-adjusted increase); industry pledges do not protect children aged >11 years, and some marketing appears to have shifted to older children; and, nutritional content remains poor. Continued monitoring of and improvements to food marketing to youth are needed.

Behind‐the‐Counter Statins: A Silver Bullet for Reducing Costs and Increasing Access?

To examine how the 2004 introduction of behind-the-counter (BTC) simvastatin in the United Kingdom affected utilization, prices, and expenditures. Secondary data on simvastatin utilization, prices, and expenditures between 1997 and 2007 in the United Kingdom and four other countries. We used a difference-in-differences approach to estimate how the introduction of BTC simvastatin affected utilization, prices, and expenditures. This approach compares outcomes in the United Kingdom before and after the introduction of BTC simvastatin, using outcomes in countries where the drug remained prescription only to control for possible confounders. Data on simvastain utilization, prices, and expenditures between 1997 and 2007 in the United Kingdom and four other countries were obtained from an outside vendor. The introduction of BTC simvastatin in the United Kingdom led to a significant increase in utilization of simvastatin and a significant decline in expenditures for simvastatin purchases. Our results are robust to alternate model specifications. Behind-the-counter statins have the potential to simultaneously increase use of statins and lower expenditures.

The role of energy efficiency spending in Maryland’s implementation of the Regional Greenhouse Gas Initiative

What are the economic consequences of increased state spending on electricity consumption efficiency? The State of Maryland faces this question in deciding how much of its CO 2 allowances auction proceeds (under the Regional Greenhouse Gas Initiative) to devote to such programs. Starting at a base of 25% of the proceeds, we consider the energy savings, emissions reductions, employment, and other impacts of increasing that percentage to 50% and 100%. A series of models – Haiku, JHU-OUTEC, and IMPLAN – are used for the analysis. We conclude that increasing the state’s expenditures on energy efficiency programs would result in a decline in electricity consumption in the state and a corresponding decline in expenditures on electricity. Program implementation would lead to net positive growth in statewide economic activity and include growth in both jobs and wages.