Excessive Spending Research Articles

Excess Medical Care Spending: The Categories, Magnitude, and Opportunity Costs of Wasteful Spending in the United States

Landmark reports from reputable sources have concluded that the United States wastes hundreds of billions of dollars every year on medical care that does not improve health outcomes. While there is widespread agreement over how wasteful medical care spending is defined, there is no consensus on its magnitude or categories. A shared understanding of the magnitude and components of the issue may aid in systematically reducing wasteful spending and creating opportunities for these funds to improve public health.To this end, we performed a review and crosswalk analysis of the literature to retrieve comprehensive estimates of wasteful medical care spending. We abstracted each source's definitions, categories of waste, and associated dollar amounts. We synthesized and reclassified waste into 6 categories: clinical inefficiencies, missed prevention opportunities, overuse, administrative waste, excessive prices, and fraud and abuse.Aggregate estimates of waste varied from $600 billion to more than $1.9 trillion per year, or roughly $1800 to $5700 per person per year. Wider recognition by public health stakeholders of the human and economic costs of medical waste has the potential to catalyze health system transformation.

Reduction in US Health Care Spending Required to Meet the Institute of Medicine's 2030 Target.

Objectives. To quantify changes in US health care spending required to reach parity with high-resource nations by 2030 or 2040 and identify historical precedents for these changes.Methods. We analyzed multiple sources of historical and projected spending from 1970 through 2040. Parity was defined as the Organisation for Economic Co-operation and Development (OECD) median or 90th percentile for per capita health care spending.Results. Sustained annual declines of 7.0% and 3.3% would be required to reach the median of other high-resource nations by 2030 and 2040, respectively (3.2% and 1.3% to reach the 90th percentile). Such declines do not have historical precedent among US states or OECD nations.Conclusions. Traditional approaches to reducing health care spending will not enable the United States to achieve parity with high-resource nations; strategies to eliminate waste and reduce the demand for health care are essential.Public Health Implications. Excess spending reduces the ability of the United States to meet critical public health needs and affects the country's economic competitiveness. Rising health care spending has been identified as a threat to the nation's health. Public health can add voices, leadership, and expertise for reversing this course.

Does cyber tech spending matter for bank stability?

CyberTech has drawn academic attention in the aftermath of the global financial crisis (GFC) as banks were forced to embrace CyberTech more aggressively to cope with market competition after the crisis. Banks can improve their operational efficiency and quality of service by relying on CyberTech, but they become more vulnerable to cybersecurity. Thus, increasing investment in CyberTech becomes a strategic necessity for banks to combat cybersecurity hazards. The study investigates how disruptive digital transformation affects bank stability. In particular, it examines whether the law of diminishing marginal returns from overspending on CyberTech affects bank stability. Based on a global sample from 43 countries, we find that an increase in CyberTech spending above the threshold level adversely affects the stability of banks. The main reason behind the adverse effect of CyberTech spending on the stability of banks is that banks take more than the proportional risk for every dollar they spend on disruptive CyberTech after they cross a threshold level of spending. While results persist across sub-samples, our results indicate two important channels of technological regimes – a diminishing returns regime and an increasing returns regime. The diminishing returns regime improves bank stability through more aggressive spending on technology, and the increasing returns regime makes banks more unstable due to excess spending on disruptive CyberTech. The study has implications for cybersecurity and sustainable CyberTech spending for banks.

Assessing the future medical cost burden for the European health systems under alternative exposure-to-risks scenarios.

BackgroundAgeing populations and rising prevalence of non-communicable diseases (NCDs) increasingly contribute to the growing cost burden facing European healthcare systems. Few studies have attempted to quantify the future magnitude of this burden at the European level, and none of them consider the impact of potential changes in risk factor trajectories on future health expenditures.MethodsThe new microsimulation model forecasts the impact of behavioural and metabolic risk factors on NCDs, longevity and direct healthcare costs, and shows how changes in epidemiological trends can modify those impacts. Economic burden of NCDs is modelled under three scenarios based on assumed future risk factors trends: business as usual (BAU); best case and worst case predictions (BCP and WCP).FindingsThe direct costs of NCDs in the EU 27 countries and the UK (in constant 2014 prices) will grow under all scenarios. Between 2014 and 2050, the overall healthcare spending is expected to increase by 0.8% annually under BAU. In the all the countries, 605 billion Euros can be saved by 2050 if BCP is realized compared to the BAU, while excess spending under the WCP is forecast to be around 350 billion. Interpretation: Although the savings realised under the BCP can be substantial, population ageing is a stronger driver of rising total healthcare expenditures in Europe compared to scenario-based changes in risk factor prevalence.

Does CyberTech Spending Matter for Bank Stability?

CyberTech has drawn academic attention in the aftermath of the global financial crisis (GFC) as banks were forced to embrace CyberTech more aggressively to cope with market competition after the crisis. Banks can improve their operational efficiency and quality of service by relying on CyberTech, but they become more vulnerable to cybersecurity. Thus, increasing investment in CyberTech becomes a strategic necessity for banks to combat cybersecurity hazards. The study investigates how disruptive digital transformation affects bank stability. In particular, it examines whether the law of diminishing marginal returns from overspending on CyberTech affects bank stability. Based on a global sample from 43 countries, we find that an increase in CyberTech spending above the threshold level adversely affects the stability of banks. The main reason behind the adverse effect of CyberTech spending on the stability of banks is that banks take more than the proportional risk for every dollar they spend on disruptive CyberTech after they cross a threshold level of spending. While results persist across sub-samples, our results indicate two important channels of technological regimes – a diminishing returns regime and an increasing returns regime. The diminishing returns regime improves bank stability through more aggressive spending on technology, and the increasing returns regime makes banks more unstable due to excess spending on disruptive CyberTech. The study has implications for cybersecurity and sustainable CyberTech spending for banks.

Fiscal councils’ impact on promoting transparency and accountability in public finance management

This paper addresses two main questions: (1) how far do the activities of fiscal councils in the EU countries help promote transparency and accountability in the management of public finances and (2) how could fiscal councils enhance the impact of those activities? The analysis is based on a questionnaire collected in 2016 from fiscal councils in 18 EU countries. The questionnaire looked at how the councils themselves assessed their impact on the management of public finances, and how they communicated their findings to the wider public. The councils see some benefits of their work; and their monitoring of adherence to fiscal rules and legislative regulation, as well as their warnings about excessive government spending, seem to get noticed in the media. This activity informs the public, and may in turn influence politicians’ ratings, thereby helping to contribute to greater accountability in the management of public finances. The paper consequently argues that fiscal councils may promote fiscal transparency and accountability and proposes several ways to enhance the effectiveness of their influence on media.

The effects of fiscal governance on fiscal performance in Sub‐Saharan Africa

AbstractFiscal governance implemented around the globe offer useful information on the potential viable reasons for its increasing dependence and their implication for fiscal performance. This paper investigates the effects of fiscal governance in explaining the fiscal performance of countries in Africa. The paper uses a panel data of 43 countries from worldwide databases spanning from 1985 to 2011. The random effects model approach is used to analyse the data based on the diagnostic tests. Additionally, the panel corrected standard errors and Hausmann and Taylor estimation models are used to test the robustness of our results to further correct for possible errors and endogeneity in the regressors. The empirical analysis shows that fiscal policy rules and institutions have statistically significant effect on fiscal performance. The results from all the methods indicate higher coefficients of the expenditure rule relative to the other rules. This trend suggests the suitability of the adoption of the expenditure rule within the Sub‐Saharan African environment. This could be partly explained by the fact that, the restrictions placed on expenditures with the aim of controlling excessive spending behaviours of fiscal authorities have been very successful in influencing fiscal deficits in Sub‐Saharan Africa. This study contributes to the literature on the implication of the adoption of fiscal governance in African countries. The policy message to stakeholders is that, fiscal governance should be further strengthened to improve fiscal performance.

Sustainability of the Brazilian public debt: An analysis using multicointegration

According to Bohn (1995), conventional econometric analysis of sustainability, based on unit root tests on the government debt-to-GDP series or cointegration analysis between revenues and expenses, are inconclusive to verify the sustainability of the fiscal policy. This paper uses the multicointegration method to investigatethe validity of a long-term relationship between the Brazilian government`s accumulated revenues and expenses and its debt, all expressed as a proportion of GDP. Leachman et al. (2005) argue that this technique allows concluding about the sustainability or not of fi scal policy. The present work considers specificationsthat allow evaluating the reaction of both accumulated revenues and expenses to changes in the debt-to-GDP, using monthly data from December 1997 to June 2018. We conclude that the Brazilian fiscal policy was unsustainable over the study period, due to the excessive government spending and its growing trajectory, mainly at the end of the sample.

The Impact of Impulsivity and Emotional Dysregulation on Comorbid Bipolar Disorder and Borderline Personality Disorder.

The symptomatic overlap between borderline personality disorder (BPD) and bipolar disorder (BD) is a topic of scientific and academic debates. Emotional dysregulation and impulsivity are common features of both disorders. Several studies have shown that both BPD and BD lie on a spectrum; others have suggested that they are separate entities that coexist. BPD is characterized by impulsive and dangerous behaviors such as driving recklessly, inappropriate sexual behavior, eating disorders, and substance abuse. BD, during a manic episode, is known for their impulsive and risk-taking behavior like hypersexuality, excessive spending, and substance abuse. The current literature review aims to provide an overview of the impact of impulsivity and emotional dysregulation on comorbid bipolar disorder and borderline personality disorder. Our study results showed that patients with comorbid BPD and BD struggle with impulsive actions and have difficulty controlling their emotions. They are also highly susceptible to anxiety disorders like obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and somatoform disorders. Patients with comorbid BPD and BD struggle with severe psychosocial morbidity and an increased risk of suicide. In patients with only one disease, misdiagnosis is a common phenomenon due to the overlapping symptoms of BPD and BD.

US Spending Associated With Transition From Daily to 3-Times-Weekly Glatiramer Acetate

Market exclusivity for daily injections of glatiramer acetate, a disease-modifying therapy for multiple sclerosis, expired in 2015. In 2014, the manufacturer launched an alternate 3-times-weekly version that was widely adopted, sustaining market dominance of brand-name glatiramer until late 2017. To estimate excess US spending associated with the transition from daily to 3-times-weekly glatiramer. This economic evaluation estimated total US glatiramer spending from January 1, 2011, to June 30, 2019, using a national cohort from 3 data sources that collectively represent approximately 40% of the US glatiramer market: Medicare Part D, Medicaid, and a claims database of commercially insured and Medicare Advantage patients. Calendar quarter. Outcomes were quarterly US glatiramer spending, estimated as price × use. Manufacturer list prices for generic products and estimates of net (postrebate) prices for brand-name products were used. Linear regression and interrupted time series models were used to compare spending trends in 3 periods: before generic competition (2011-2015), during generic competition for daily glatiramer (2015-2017), and during generic competition for daily and 3-times-weekly glatiramer (2017-2019). From 2011 to 2015, US glatiramer spending increased to $962 million per quarter and did not decrease with generic competition of only daily glatiramer (2015-2017). After generic competition began for 3-times-weekly glatiramer in 2017, prices decreased by 47% to 64%, and spending decreased to $508 million per quarter in 2019 (P < .001 for slope). The delay in decreased spending from 2015 to 2017 was associated with excess spending of $4.3 billion to $6.5 billion. These findings suggest that 2.5 years of delayed generic competition related to introduction of a new version of branded glatiramer acetate was associated with $4.3 billion to $6.5 billion in excess spending. Extended market exclusivity from introducing a new version of an existing brand-name drug can yield manufacturer returns out of proportion to the level of investment or risk involved; more limited incentives could encourage incremental innovations to existing drugs at a lower societal cost.

The Economic Crisis and the Role of External Audit: The Case of Greece

The global financial crisis of 2008 has been rivaled only by the Great Depression of the 1930s. The breadth and duration of this crisis had an adverse impact on every national economy, reflecting the systemic interdependence of an interconnected economic ecosystem, and the strengths and weaknesses of individual countries, regions, and monetary policies. The economic crises was particularly disparaging to the Greek state, which has a long history of excessive public spending, massive tax evasion, wage growth not supported by proportional productivity, and unsustainable debt levels. The health of the economy was further eroded as a result of a lack of confidence that was driven by questionable accounting practices and the misreporting of economic performance indicators by successive governments. The Court of Audit of the Hellenic Republic1 operates as the independent external auditor for the Greek state. Its effective and efficient operation within its mandated boundaries will be instrumental in the nation’s economic recovery and a key preventing measure to arrest financial mismanagement in the future. This work will describe the context in which the CoA carries out its activities, and will explore the means through which the organization can apply a systems approach to its structure, function, and management paradigm for the purpose of reinforcing its strategic, operational, and tactical capacity.

Value-Based Payment Reforms in Cardiovascular Care: Progress to Date and Next Steps.

In an effort to curb excessive health care spending and incentivize high-quality care, many payers have implemented value-based payment reforms designed to pay for the quality rather than the quantity of health care services. Medicare, the largest payer in the United States, has implemented numerous value-based payment policies over the past decade, many of which affect cardiovascular care. In this review, we discuss some of these major nationwide value-based payment reforms as they relate to cardiovascular care and what we may expect in the future from cardiovascular value-based policies.

New Evidence for Romania Regarding Dynamic Causality between Military Expenditure and Sustainable Economic Growth

Military spending and sustainable economic development have been widely discussed in recent decades. Especially in Romania, the defense budget is valued at $4.8 billion, registering a compound annual growth rate (CAGR) of 23.57%. It is also expected to reach $7.6 billion in 2023, according to a report by Strategic Defense Intelligence. There is no consensus in current research and less attention is paid to Eastern European countries. Considering the significant increase in military spending in Romania in recent years, as well as the occurrence of political events, this paper focuses on the dynamic causal relationship between military spending and sustainable economic growth in Romania. The bootstrap rolling window causality test takes into account the structural changes, and therefore, provides more convincing results. The results indicate negative effects of military expenditure on sustainable economic growth between 1996–1999 and 2002–2004. It can be attributed to the crowding-out effect of public expenditure on private investment. The positive effect between the two variables analyzed is noticed with the accession of Romania to the North Atlantic Treaty Organization. Conversely, it is found that economic growth does not have a significant effect on military spending in Romania. Policymakers should guard against the crowding out of private consumption and investment due to excessive military spending and ensure to increase military expenditure on the premise of sustainable economic development.

The role of reward sensitivity in obesity and its association with Transcription Factor AP-2B: A longitudinal birth cohort study

ObjectiveOne factor potentially contributing to obesity is reward sensitivity. We investigated the association between reward sensitivity and measures of obesity from 9–33 years of age, paying attention to the inner structure of reward sensitivity. MethodsThe sample included both birth cohorts (originally n = 1176) of the Estonian Children Personality Behaviour and Health Study. The association between reward sensitivity and measures of obesity was assessed using mixed-effects regression models. Associations at ages 9 (younger cohort only), 15, 18, 25 and 33 (older cohort) years were analyzed by one-way ANOVA. The indirect effect of the gene encoding transcription factor 2 beta (TFAP2B) on obesity through reward sensitivity was tested using mediation analysis. ResultsAccording to linear mixed effects regression models, an increase in scores of Insatiability by Reward and both of its components, Excessive Spending and Giving in to Cravings, significantly increased body weight, body mass index, sum of five skinfolds, waist circumference, hip circumference and waist-to-height ratio from 15 to 25 years of age. Findings were similar at age 9 and 33 years. In contrast, no association between obesity and Openness to Rewards or its facets was observed. The TFAP2B genotype was also associated with fixation to rewards in females, but not with striving towards reward multiplicity. ConclusionOur results suggest that reward sensitivity is associated with obesity by its reward fixation component. The heterogeneity of the reward sensitivity construct should be taken into account in studies on body composition.

Estimating The Cost Of Delayed Generic Drug Entry To Medicaid.

Delays in market entry of generic drugs are common. This study sought to identify the prevalence of delayed entry, the reasons for the delays, and the delays' effects on Medicaid spending in a recent cohort of brand-name medications. We estimated excess Medicaid spending in 2010-16 in the delayed quarter-years after accounting for market average predictions of brand-name market share, ratios of generic to brand-name prices, and Medicaid rebates (60percent for brand-name and 15percent for generic drugs). Among sixty-nine brand-name drugs that were predicted to lose market exclusivity, generic entry occurred either before or within a quarter-year of the expected date for thirty-eight products (55percent), was delayed by more than one quarter for twenty products (29percent), and did not occur for eleven products (16percent). For the thirty-one products (45percent) for which generic entry was delayed by more than one quarter or did not occur, Medicaid spent an estimated excess of $761million over seven years ($109million annually). Patent litigation was the most common cause of generic entry delays. Policies that expedite the resolution of patent challenges are needed to ensure the timely entry of generic drugs.

How to Increase Transparency and Promote Value in Healthcare: Information plus Incentives

The cost of healthcare in the United States is a major concern, and the prices of goods and services are a key contributing factor to excessive healthcare spending. However, patients in the United States rarely know what services cost beforehand, preventing them from making informed decisions about the value of the care they receive. Although price transparency tools are widely available, barriers such as a lack of awareness and the current structure of health plan benefits limit their use and effectiveness. Price transparency could have a large impact on the healthcare marketplace and lead to greater competition, increased value, and more efficient allocation of resources, but only if designing a robust incentive structure for consumers is a primary concern. In addition to reforming the current insurance-based system, policymakers should pursue “forward-looking” policies that disrupt the status quo by allowing consumers greater ownership of their healthcare resources and facilitating more direct transactions between consumer and provider.

A self-control theory perspective on tourists’ short-vacation preference: empirical evidence from China

ABSTRACT Based on a nationwide survey, it is proposed that short-vacation preference exists in the Chinese domestic tourist market. Introducing self-control theory from behavioral economics, this study constructed a conceptual framework and conducted an empirical exploration to identify the economic effect of different types of holiday vacations. It verified that domestic Chinese tourists usually spend more on short vacations to avoid excessive spending in the future due to self-control. This study has empirically verified and generalized the applicability of self-control theory in the tourism field, thus providing a richer analytical tool and a deeper understanding of tourist consumption behaviors.

Reducing Medication Waste While Improving Access to Sugammadex: A Quality Improvement Project in Medication Stewardship.

The relatively high cost of sugammadex compared to neostigmine limits its widespread use to reverse neuromuscular blockade, despite its faster onset and more complete clinical effect. While ensuring timely access to sugammadex is important in improving perioperative safety, it is also vital to control unnecessary spending. We describe a quality improvement initiative to reduce excess spending on sugammadex while improving access for anesthesia providers. Monthly spending on sugammadex decreased by 52% ($70,777 vs $33,821), while medication access increased via automated medication dispensers in each operating room. Clinical usage decreased by one-third, with presumed increased adherence to dosing guidelines.

Pengaruh Harga dan Promosi terhadap Impulse Buying pada Produk Online Menurut Ekonomi Syariah

Advances in internet technology currently make online shopping systems become instant and very popular. This study aims to determine the analysis of the Effect of Prices and Promotions on Impulse Buying in Online Products According to Islamic Economics. Where the results of the pre-survey to students of the Faculty of Islam about Online products on the influence of prices and promotions on impulsive purchases. The sampling technique in this study used a purposive sampling technique by taking a sample of 100 respondents. This research uses a quantitative approach with the method of data analysis of Multiple Linear Regression with the help of the SPSS Program Application Version 21.0 for Windows. The results of this study indicate that there is an effect of Price and Promotion on the performance of Impulse Buying on online products. As well as the effect of Price and Promotion on Impulse Buying in the Sharia Economy perspective on the influence of consumer behavior on purchasing decisions via mobile phones they apply concepts that are in accordance with the teachings of Islam that is not beyond the limits of reasonableness, and positively. Because the Al-Qur'an forbids excessive spending on wealth solely following the passions, while on the other hand also condemns the act of distancing yourself from the pleasure of enjoying things that are good and lawful in life.Keywords: Price, Promotion, Impulse Buying, Online Products, Sharia Economy.

A Comment on Georgia Department of Economic Development Report: ‘The Economic Impact of the Film Industry in Georgia’

This article comments on the recent economic impact report (Meek Report) commissioned by Georgia Department of Economic Development (GDEcD) on the economic impact of the film industry in Georgia. • Following the charge of the GDEcD, the Meek Report examines only the benefits of the film industry and does not consider the costs of the state’s film tax credit program. The state has issued nearly $5 billion in film tax credits since 2008, and it approved $860 million in film tax credits during FY 2019. The annual amount of forgone tax revenue represents approximately three percent of the state-funded budget or $230 dollars per Georgia household. • Though the Meek Report acknowledges the existence of the strong body of research on film incentives and economic growth, it does not report the consensus findings of existing studies, which do not support the hypothesis that film incentives have a net positive impact on state economies. • Rather than use available records of direct spending on film production from state government agencies, the Meek Report concocts an estimate of direct spending using a dubious method that is not adequately described, nor does it appear to be sound. The estimated direct spending estimate is inconsistent with other available measures and is not credible. • The Meek Report uses an excessive multiplier to estimate indirect and induced effects from film production spending. The origins of the multiplier are not explained, and when combined with the excessive direct spending estimate, it inflates total economic impact well above its likely impact. • Film employment can provide a misleading representation of the industry’s impact on the Georgia economy. Recent growth in film industry jobs likely reflects a shift from full-time to part-time workers. • Using the Meek Report’s estimate of film industry jobs, the cost of film tax credits is $49,000 per job, (full-time and part-time). When GDEcD film employment data is adjusted for full-time equivalency (FTE), the cost is $110,000 per FTE job. • The Meek Report highlights that the average wage for film jobs exceeds the average wage of the state. The comparison of averages is misleading, because the mean is skewed upwards by the exceptional salaries of a few actors, directors, etc. who are not representative of typical Georgia film workers. The median wage of US film workers equates to $39,000 (FTE), which is below the median wage of $48,000 of all jobs. Typical film workers do not earn high wages. • The methods and data described in the Meek Report do not support its claims that the film industry is responsible for $8.6 billion in output or 51,000 jobs. Available records of direct film production spending combined with reasonable multipliers results in an estimated economic impact of Georgia’s film industry of between $3.4 and $5 billion in total output and around 30,000 total jobs. • Direct film spending represents close to $3 billion of Georgia’s economy, which is approximately 1/200th of the state’s $600 billion economy. While film production in Georgia may exceed other states, contrary to popular perception, the film industry is not a major driver of economic output or jobs in the state.