Expenditure Profiles Research Articles

Evolución de la prestación real media en España por edad y sexo (1998-2008) y su repercusión en las proyecciones de gasto sanitario público

ObjectivesTo analyze changes in real per capita spending by age and sex from 1998 to 2008 in Spain, and to assess their effects on public healthcare expenditure projections. MethodsAge- and sex-related expenditure profiles in constant terms were estimated for the Spanish population for 3 distinct years (1998, 2003 and 2008) by using data from hospital records and several National Health Surveys. These profiles were used to compare actual healthcare expenditure for 2003 and 2008 with the projections obtained by considering 1998 as the base year and by applying the methodology used by the Working Group on Aging of the European Union. ResultsThe average annual growth rate of real per capita spending per person from 1998 to 2008 was 2.79%, which was higher than the GDP per capita growth rate (1.90%), basically due to its high rate of increase in the second half of the decade. From 1998 to 2008, per capita healthcare expenditure increased in most age groups, particularly in the groups aged 45-49 years, 60-64 years and 75 years and older. Projections of per capita expenditure in constant terms covered the real value observed for 2003, but were below the real value for 2008. ConclusionsChanges in the quantity and quality of healthcare services consumed by each person are an important factor in changes in healthcare expenditure and must be included in spending projections.

Ramanagaram Financial Diaries: Loan Repayments and Cash Patterns of the Urban Slums

We provide the preliminary analysis of a three month pilot study tracking the daily cash inflows and outflows of twenty households in two urban slums of Ramanagaram, indebted to micro-credit organizations. Indebtedness of many of these households to multiple MFls was a result that came out very strongly from the analysis of the daily cash transactions of these financial diaries. Secondly, a rather disturbing finding related to this, is the size of each household's budget that goes towards servicing loan repayments. Loan repayments vied with food in the expenditure profiles of most of these households. Reinforcing this is our third finding that households are observed to recycle their debts to a substantial extent as evidence by over 27% of borrowings being used to finance various kinds of borrowings (including MFI and SHG borrowings). The fact that most of these borrowings are taken as small sums from several entities also does not boost the use of these funds towards productive purposes. All this points towards some pressing issues that need to be addressed in the fast-track growth of the microfinance sector in urban India.

Financing Nigeria’s Colonial Administration: A Comparative Study of its Revenue and Expenditure Profiles, 1940 – 1960

This study attempts to show how colonial treasury and fiscal plannerscreated and sustained the policy of balance/surplus budget from 1940 to1960 in Nigeria. The study places the fiscal operations of the government incolonial Nigeria during the period in historical perspective and offers an analysis of the structure and relationships of revenue and expenditure of thegovernment within the context of a dependent economy. The approachadopted is at once historical and analytical showing how colonial fiscalpolicies of deliberate diminution of public expenditure helped to sustain atrend in fiscal balance even when that affected investment in the criticalareas of infrastructure development and promoted an expenditureorientation that favoured the recurrent at the expense of the capital budget.

Relation between body mass index and resting metabolic rate, cardiorespiratory fitness and insulin sensitivity in Sasang typology for young male persons: An observational study

IntroductionMetabolic efficiency and low physical fitness may be determined by inherited genetic factors and implicated in the increasing prevalence of obesity and metabolic disorders. Aim of the studyThis study examines the distinctive characteristic in energy expenditure (EE) profile, physical fitness, and obesity-linked biomarkers across Sasang types. MethodologyEE at fasting and postprandial states, physical fitness including maximal oxygen consumption (VO2max) and time to exhaustion (Te) were measured by an indirect calorimeter in 51 young male participants. Plasma insulin concentration and HOMA-IR indices before and after eating were analyzed. ResultsNo difference was found in resting metabolic rate (RMR), thermic effect of food (TEF), VO2max, Te, and in plasma insulin and glucose concentration, and HOMA-IR indices before and after eating. Body mass index (BMI) contributed to the increase of RMR in the SoYang (SY) type (n=17), but not in the TaeEum (TE) (n=17) and SoEum (SE) (n=17) types, whereas BMI was inversely associated with the physical fitness in the TE and SE types, but not in SY type, and BMI was positively related to the plasma insulin concentration and insulin sensitivity in the TE type before and after eating, but not in the SE and SY types. ConclusionTogether, it can be assumed that high BMI is related to health risk in the TE and SE types, especially in the TE type, but not in the SY type.

The Crisis, Automatic Stabilisation, and the Stability Pact

This paper describes recent trends on the effectiveness of stabilisers in the European Union. Using both macro evidence on the cyclical sensitivity of budget deficit to economic activity and micro evidence on the tax and expenditure profiles, we conclude, in agreement with the recent literature, that the importance of automatic stabilisation has decreased. After remarking that this trend is contradictory with the current economic institutions of Europe, which rely exclusively on automatic stabilisation for the conduct of fiscal policy, we argue that increasing flexibility, one alternative way to reduce cyclical fluctuations, does not seem a viable path. The paper concludes defending the appropriateness of discretionary fiscal policy. We argue by means of a simple model that the theoretical arguments against its use are not conclusive, and we describe a recent stream of literature, based on structural VAR models, that concludes rather robustly for the effectiveness of discretionary fiscal policy in the short and long run.

Visitors of Two Types of Museums: Do Expenditure Patterns Differ?

This study aims at estimating and comparing the determinants of expenditure behaviour of visitors in two types of museums. An ad-hoc survey was conducted between June and September 2011 among the visitors of the principal museums of the two provinces of Bolzano and Trento: the South Tyrol Museum of Archeology (Bolzano), hosting the permanent exhibition of the “Iceman” Otzi, and the Museum of Modern and Contemporaneous Art of Trento and Rovereto (MART). The double-hurdle procedure of Heien and Wessels (1999) is used in order to obtain consistent estimates and split the process of spending decision into the stages of ‘activation’ and ‘outcome’. Results highlight two distinct profiles of visitors. Spending of the modern art museum visitor was positively related to her cultural interest, whereas the expenditure profile of the archaeological museum guest was more ‘generalist’.

Tax-and-Spend Principle in Budget Management in Sri Lanka in the Post-reform Period

The correlation between a government’s expenditure and revenue has attracted a lot of interest thanks to its policy relevance. This paper delves into the fiscal adjustment process through the expenditure and the revenue of Sri Lanka in the post-reform era from 1979 to 2009. The Augmented Dickey–Fuller study for the unit root testifies that both expenditure and revenue in Sri Lanka over the period have been I(0) stationary. The vector autoregression (VAR) model along with innovation accounting show that one-year lagged revenue leads to a rise in government expenditure in the next period. Revenue innovations also have a significant role in changing the expenditure profile. These findings uphold the tax-and-spend approach as the prevalent feature of the Sri Lankan economy’s fiscal system over the period of this study. Therefore, fiscal adjustments based on the revenue side of the budget need to be analysed.

Airport performance: A rating agency perspective

This paper is a summary of the author's presentation at Airports Council International's Airport Economics and Finance conference in March 2011. The 2008–09 economic crisis resulted in some spectacular falls in traffic across European airports. Yet certain airports were able to sustain satisfactory financial performance despite exceptionally adverse economic conditions. Several conclusions can be drawn from this. First, the downturn revealed sharp differences in traffic volume across various European airports. Major hub airports and a few strong origin and destination airports demonstrated good traffic and revenue resilience during the crisis. This resilience is mainly a function of the airport's role in the aviation system: first-tier airports, ie those serving the largest and most vibrant economic areas, offering the best yield for airlines and the most convenient flights for passengers, performed better during the crisis. Secondly, many European airports have succeeded in increasing their commercial revenues thanks to enlargements and improvements to their retail and food and beverage offering. The revenue per passenger has therefore often increased against a backdrop of economic recession. Thirdly, key airports have adapted their expenditure profiles. During the recent crisis, many airports managed their expenditure profiles by rescheduling capital spending and taking action on the cost base.

The Political Economy of Active Labor-Market Policy

Active labor-market policies (ALMPs) have developed significantly over the past two decades across Organization for Economic Cooperation and Development (OECD) countries, with substantial cross-national differences in terms of both extent and overall orientation. The objective of this article is to account for cross-national variation in this policy field. It starts by reviewing existing scholarship concerning political, institutional, and ideational determinants of ALMPs. It then argues that ALMP is too broad a category to be used without further specification, and it develops a typology of four different types of ALMPs: incentive reinforcement, employment assistance, occupation, and human capital investment. These are discussed and examined through ALMP expenditure profiles in selected countries. The article uses this typology to analyze ALMP trajectories in six Western European countries and shows that the role of this instrument changes dramatically over time. It concludes that there is little regularity in the political determinants of ALMPs. In contrast, it finds strong institutional and ideational effects, nested in the interaction between the changing economic context and existing labor-market policies.

Effects of tenure and land use factors on food security among rural households in the dry Savannas of Nigeria

Defining food security in terms of availability and access to sufficient food to meet dietary needs for a productive and healthy life, this paper assessed the effects of property rights to land on household food security in the Savanna zone of northern Nigeria. The paper analyzed household expenditure profile, examined households’ tenure and land use factors, determined the effect of these factors on household foodsecurity status, and predicted/classified households into food security groups based on these factors. Primary data were generated from a cross-section of 180 farming households during the 2006/2007 production season, using pre-tested structured questionnaire. Data were collected on tenure and land use characteristics, input-outputrelationships, cropping patterns, land improvement techniques, and on household expenditure and income. Focus group discussions and key informant interviews were also conducted. Secondary data were obtained from Local Government secretariats and the National Population Commission. Data were analyzed using descriptivestatistics, probit regression and discriminant techniques. Results showed that the customary tenure arrangement is the most important way by which farm households gain access and manage land in the zone. On the average, households cultivated less than two hectares of land with less than two years of fallow. Inorganic fertilizer was the most commonly used land improvement technique by all households, but at rates below recommended dosage due to scarcity and high cost. Only 25% of the households were categorized as food secure and 75% as food insecure. Expenditure on food accounted for over 30% of total expenditure and was significantly higher for the food secure households. Probit estimates revealed that age, farm size, use of land improvement techniques, membership of association, and access to extension service were significant determinants of households’ food security options, while these factors except age were identified as the most powerful discriminators and predictors of household’s food security options using discriminant analysis, with 92.7% of the sampled households correctly and satisfactorily classified. This suggests thatmeaningful land intensification through proper management and effective extension service is the likely development pathway in the study area. In addition, the classification of households can support policy making strategies that target specific groups for government and non-government programme implementation.

The Political Economy of Active Labour Market Policy

Active labour market policies have developed significantly over the last two decades across OECD countries, with substantial cross-national differences in terms of both extent and overall orientation. The objective of this paper is to account for cross-national variation in this policy field. It starts by reviewing existing scholarship concerning political, institutional and ideational determinants of ALMPs. It then argues that ALMPs is too broad a category to be used analytically, and develops a typology of four different types of ALMPs: incentive reinforcement, employment assistance, occupation, and human capital investment. These are discussed and examined through ALMP expenditure profiles in selected countries. The paper uses this typology to analyse active labour market policy trajectories in six western European countries, and shows that the role of this instrument changes dramatically over time. It concludes that there is little regularity in the political determinants of ALMPs. In contrast, it finds important institutional and ideational effects, the latter in the most recent phase in particular.

Financing State Governments in Nigeria, 1980-2007

State governments in Nigeria are saddled with a lot of responsibilities thatare geared towards the development of their areas. To do this, they engage in expenditure profiles that are at times overwhelming, especially whencompared with their limited financial resources. This problem of insufficientfunding sources and over-dependence on external sources was investigated by this study using multiple regression analysis technique. It was found that while Federal allocation, internally-generated revenue and stabilization fund, were significant sources of financing state government expenditure in Nigeria, loans, grants and value added tax were not significant. Therefore, strategies for beefing up and sustaining internal revenue sources were recommended to help states strive towards financial autonomy and attracting grants for their programmes.

Energy intake and expenditure profile in chronic peritoneal dialysis patients complicated with circulatory congestion

BackgroundCirculatory congestion is an adverse predictor of mortality in peritoneal dialysis (PD) patients. ObjectiveThis study evaluated the nutritional status, energy intake, and expenditure profile of PD patients with and without previous circulatory congestion. DesignWe conducted a cross-sectional study in 244 PD patients, of whom 92 had previous circulatory congestion. We estimated dietary energy intake by using a locally validated 7-d food-frequency questionnaire and by assessing resting energy expenditure (REE) and total energy expenditure (TEE) with indirect calorimetry and a locally validated physical activity questionnaire, respectively. ResultsIn comparison with those without circulatory congestion, patients with previous circulatory congestion were more malnourished by subjective global assessment (59% compared with 36%; P < 0.001), had lower handgrip strength, had lower midarm muscle circumference, had lower dietary protein (0.98 ± 0.45 compared with 1.19 ± 0.44 g · kg−1 · d−1; P < 0.001), and had lower energy intake (92.5 ± 37.0 compared with 110.9 ± 35.7 kJ · kg−1 · d−1; P < 0.001) but had higher C-reactive protein (P = 0.025) and higher REE (P < 0.001). However, no difference in TEE was noted between the 2 groups, which indicated lower activity energy expenditure among patients with previous circulatory congestion. The resulting energy balance was significantly more negative for patients with previous circulatory congestion than for those without previous circulatory congestion (P = 0.050). Furthermore, the prevalence of malnutrition increased with increasing episodes of circulatory congestion (P = 0.017). ConclusionsPatients with previous circulatory congestion had significantly more inflammation, more muscle wasting, and higher REE but lower activity energy expenditure and energy and protein intakes in keeping with an anorexia-cachexia syndrome. The mechanisms of increased REE and reduced energy intake among patients with previous circulatory congestion warrant further investigation.

Ghrelin restores ‘lean-type’ hunger and energy expenditure profiles in morbidly obese subjects but has no effect on postgastrectomy subjects

To examine the effects of ghrelin on appetite and energy expenditure in lean, obese and postgastrectomy subjects. A randomized, double-blind, placebo-controlled study. Nine lean subjects (mean body mass index (BMI) 23.5+/-3 kg/m(2)) and nine morbidly obese subjects (mean BMI 51.4+/-10 kg/m(2)) and eight postgastrectomy subjects (mean BMI 22.4+/-1.0 kg/m(2)). Subjects were infused with either intravenous ghrelin (5 pmol kg(-1) min(-1)) or saline over 270 min. They were given a fixed energy breakfast followed by a free buffet lunch towards the end of the infusion. Visual analogue scales were used to record hunger and energy expenditure was measured by indirect calorimetry. Ghrelin increased energy intake at the buffet lunch in lean subjects (a 41% increase, P<0.01) and obese subjects (35% increase, P=0.04) but not in postgastrectomy subjects. Lean subjects showed a characteristic preprandial rise and postprandial fall in hunger scores, which was exaggerated by ghrelin infusion. Obese subjects showed little variation in hunger scores, but a 'lean-type' pattern was restored when given exogenous ghrelin. Ghrelin had no effect on resting metabolic rate but did increase respiratory quotient (RQ) in obese subjects. Ghrelin also increased RQ variability over time in all three groups (ANOVA, P<0.001). Hunger scores are abnormal in the obese, perhaps because of impaired ghrelin secretion. The effect of ghrelin in restoring normal hunger profiles in the obese suggests causality, confirming an important role in eating behaviour. Ghrelin also increases RQ in obese humans and increased RQ variability in all groups. This suggests that ghrelin regulates substrate utilization and may promote metabolic flexibility.

Automatic Stabilisation, Discretionary Policy and the Stability Pact

This paper describes recent trends on the efficiency of stabilisers in the European Union. Using both macro evidence on the cyclical sensitivity of budget deficit to economic activity, and micro evidence on the tax and expenditure profiles, we conclude, in agreement with the recent literature, that the importance of automatic stabilisation has decreased. After remarking that this trend is contradictory with the current economic institutions of Europe relying exclusively on automatic stabilisation for the conduct of fiscal policy, we argue that increasing flexibility, one alternative way to reduce cyclical fluctuations, does not seem a viable path. The paper concludes defending the appropriateness of discretionary fiscal policy. We argue by means of a simple model that the theoretical arguments against its use are not conclusive, and we describe a recent stream of literature, based on structural VAR models, that concludes rather robustly for the effectiveness of discretionary fiscal policy in the short and long run.

Do the Age Profiles of Health Care Expenditure Really Steepen Over Time? - New Evidence from Swiss Cantons

The red herring hypothesis contends that the high health care expenditure in old age is caused by proximity to death rather than calendar age. Dissenters point to longitudinal data and claim that health care expenditure age profiles tend to steepen over time. The present paper tests the steepening claim for Swiss health insurance, covering the time period 1997 to 2006 and 25 cantons. It analyzes the cantonal health care expenditure profile of men and women, taking into account differences in the mortality rates. The study covers seven components of health care, including long-term care. By and large, no evidence is found for relevant steepening effects of age profiles for either total, or the components, of health care expenditure.

The effects of oral fat perception compared to fat ingestion on energy expenditure and appetite profile

The effects of oral fat perception compared to fat ingestion on energy expenditure and appetite profile

Hepatic knockdown of stearoyl-COA desaturase 1 via RNA interference in obese mice decreases lipid content and changes fatty acid composition

Stearoyl-CoA desaturases (SCDs) catalyze the biosynthesis of monounsaturated fatty acids from saturated fatty acids. Four scd genes have been identified in mice and three in human (including one pseudogene). Among the four mouse SCD isoforms, SCD1 is predominantly expressed in liver and adipose tissue. Mice null for the scd1 gene have reduced adiposity, increased energy expenditure and altered lipid profiles. To further evaluate the specific role of hepatic SCD1 and the potential to achieve similar desirable phenotypic changes in adult obese mice, adenovirus-mediated short hairpin interfering RNA (shRNA) was used to acutely knock down hepatic scd1 expression in ob/ob mice. Robust reductions in hepatic SCD1 mRNA and SCD1 enzymatic activity were achieved, sustained up to 2 weeks. Reduced hepatic content of neutral lipids and robust lowering of lipid desaturation indexes, but increased content of liver phosphotidylcholine were observed with SCD1 knockdown. Increased total plasma cholesterol levels were also observed. No significant changes in body weight were observed. Expression levels of several lipogenic and lipid oxidation genes were not significantly altered by short term SCD1 reduction, but UCP2 expression was increased. Our results demonstrate that significant changes to both hepatic and systemic lipid profiles can be achieved through specific knockdown of liver-expressed SCD1 in the ob/ob mouse model. However, hepatic SCD1 knockdown does not result in significant changes in body weight in the short term.

“Steeping” of Health Expenditure Profiles

If health care expenditure for the elderly grows faster than for younger people, the expenditure profiles become “steeper” – we call that “steeping”. Three instruments for measuring “steeping” are presented: (1) trend of the relation between per capita expenditure of the old and the young; (2) comparing the linear slopes of per capita expenditure in age groups; (3) trend in parameters of nonlinear modelling of expenditure profiles. Using data of the largest German private health insurer over a period of 18 years, “steeping” could be observed by all three methods in most examined insurance plans. There are some hints that steeping also occurs in Germany's social health insurance system. The impact of steeping on the sustainability of the health system is discussed. Consequences for the calculation methods in a capital-funded health insurance system and for the implicit inter-generational contract within a pay-as-you-go financed social health insurance system are analysed. The link between “steeping” and the topic of the “red herring” discussion is elaborated.

Steeping of Health Expenditure Profiles

If health care expenditure for the elderly grows faster than for younger people, the expenditure profiles become steeper - we call that steeping. Three instruments for measuring steeping are presented: (1) trend of the relation between per-capita-expenditure of the old and the young; (2) comparing the linear slopes of per-capita-expenditure in age groups; (3) trend in parameters of non-linear modelling of expenditure profiles. Using data of the largest German private health insurer over a period of 18 years, steeping could be observed by all three methods in most examined insurance plans. A prognosis for 2040 shows that per-capita-expenditure will increase by 128 percent.