Full Subsidy Research Articles

Comparison of Subsidy Schemes for Reducing Waiting Times in Healthcare Systems

This study analyzes subsidy schemes that are widely used in reducing waiting times for public healthcare service. We assume that public healthcare service has no user fee but an observable delay, while private healthcare service has a fee but no delay. Patients in the public system are given a subsidy s to use private service if their waiting times exceed a pre‐determined threshold t. We call these subsidy schemes ( s, t) policies. As two extreme cases, the ( s, t) policy is called an unconditional subsidy scheme if t = 0, and a full subsidy scheme if s is equal to the private service fee. There is a fixed budget constraint so that a scheme with larger s has a larger t. We assess policies using two criteria: total patient cost and serviceability (i.e., the probability of meeting a waiting time target for public service). We prove analytically that, if patients are equally sensitive to delay, a scheme with a smaller subsidy outperforms one with a larger subsidy on both criteria. Thus, the unconditional scheme dominates all other policies. Using empirically derived parameter values from the Hong Kong Cataract Surgery Program, we then compare policies numerically when patients differ in delay sensitivity. Total patient cost is now unimodal in subsidy amount: the unconditional scheme still yields the lowest total patient cost, but the full subsidy scheme can outperform some intermediate policies. Serviceability is unimodal too, and the full subsidy scheme can outperform the unconditional scheme in serviceability when the waiting time target is long.

Informal Groups and Health Insurance Take-up Evidence from a Field Experiment

Summary This paper presents the results of 20 randomized experiments aimed at understanding the low take-up of in-patient health insurance observed in developing countries. Take-up does not increase when participants receive information about the product, or an assistance to register, or small subsidies of 2, 10, or 30%. Take-up does not increase when the same information is provided by local respected community leaders, when participants are offered an in-kind gift (a chicken) if they register, when participants are offered the possibility to contribute lower and more frequent payments, or the possibility to pay by cellphone. A full subsidy generates a mere 45% take-up (with no retention after one year). In contrast to these low take-up rates, presenting the same information without any subsidies to existing informal groups raises take-up to 12% (still 7% after one year), as well as trust and knowledge of the product. Social networks play a major role in the adoption of health insurance. This paper provides a cost-effective way to increase take-up of health insurance, while subsidies are found to be largely ineffective at raising take-up in the long run.

Impact of Cost-Sharing Increases on Continuity of Specialty Drug Use: A Quasi-Experimental Study.

To examine the impact of cost-sharing increases on continuity of specialty drug use in Medicare beneficiaries with multiple sclerosis (MS) or rheumatoid arthritis (RA). Five percent Medicare claims data (2007-2010). Quasi-experimental study examining changes in specialty drug use among a group of Medicare Part D beneficiaries without low-income subsidies (non-LIS) as they transitioned from a 5 percent cost-sharing preperiod to a≥25 percent cost-sharing postperiod, as compared to changes among a disease-matched contemporaneous control group of patients eligible for full low-income subsidies (LIS), who faced minor cost sharing (≤$6.30 copayment) in both the pre- and postperiods. Key variables were extracted from Medicare data. Relative to the LIS group, the non-LIS group had a greater increase in incidence of 30-day continuous gaps in any Part D treatment from the lower cost-sharing period to the higher cost-sharing period (MS, absolute increase=10.1 percent, OR=1.61, 95% CI 1.19-2.17; RA, absolute increase=21.9 percent, OR=2.75, 95% CI 2.15-3.51). The increase in Part D treatment gaps was not offset by increased Part B specialty drug use. Cost-sharing increases due to specialty tier-level cost sharing were associated with interruptions in MS and RA specialty drug treatments.

Pass-Through as a Test for Market Power: An Application to Solar Subsidies

We formalize pass-through over-shifting as a simple yet underutilized test for market power. We apply this test in the market for solar energy. Specifically, we estimate the pass-through of solar subsidies to solar system prices using rich micro-level transaction and subsidy data from California. Buyers of solar systems capture nearly the full subsidy, while there is more-than-complete pass-through to lessees. We conclude that solar markets are imperfectly competitive by ruling out alternative explanations for over-shifting and reinforce this conclusion with a test of solar demand curvature. This procedure can serve to detect market power beyond the solar market. (JEL H23, H76, L13, L63, Q42, Q48)

ANALISIS SUBSIDI ANGKUTAN PERDESAAN MELALUI BIAYA OPERASI KENDARAAN (BOK) DI KABUPATEN SLEMAN

Transport services rural areas in Sleman indicate operating performance is less well in service of nine routes. There are seven trajectories do not undergo trajectory corresponding permissions are set and one route is no longer operational.There is only one route which is still running track trajectory corresponding route permit.The purpose of this study was to analyze the performance of services of nine transportation route rural areas serving the route in Sleman District currently includes analysis : route network, load factor, headway, mileage, travel time, number of passengers and the speed of the average, the actual, the waiting location of transport and analyzing the financing scheme or calculate the amount of subsidy that can be applied to integrated rural transport to urban public transport serving in Sleman. Calculation of vehicle operating costs a small bus with a full subsidy for Rp.24,406,244,917/year, the difference in operating costs subsidy of Rp.18,318,644,917/year, bus subsidy grant of Rp. 18,559,117,225/year and fuel subsidies amounted Rp. .21,105,013,047. Recommended subsidy financing scheme because it is quite logical to be implemented is a subsidy mechanism for the difference in operating costs to buy the service system with the option of using a small bus.

Housing as a Social Determinant of Health: Exploring the Relationship between Rent Burden and Risk Behaviors for Single Room Occupancy Building Residents

A growing body of health determinants research recognizes that housing and health are intimately linked. This study explores the relationship between rent burden (the ratio of rent to income) and health risk behaviors among a sample of single room occupancy (SRO) building residents. Cross-sectional data were gathered from a sample of 162 residents living in privately owned, for-profit SROs in Chicago. Findings indicated that participants who had full rental subsidies and thus were designated in a no-rent-burden category were more likely to engage in risk behaviors including illicit drug use, having multiple sexual partners, and having sex without a condom, in comparison to participants with moderate or high-rent burdens. These findings suggest that interventions to increase housing stability and affordability and bolster reliable income sources (in addition to rental subsidies) may be key in reducing risk behaviors and improving health for vulnerably housed populations such as SRO residents.

Subsidy and parental attitudes toward pediatric health care in the Tokyo metropolitan area.

In Japan, the number of municipalities that offer free medical care for children has increased. This policy, however, might unintentionally aggravate the overcrowded situation of pediatric ambulatory services in Japan. We investigated the relationship between parents' health-care seeking attitudes according to child symptom severity and the amount of copayment, as well as parents' socioeconomic and demographic factors. We used data for 4385 people from the Japanese Study of Stratification, Health, Income and Neighborhood (J-SHINE), which consisted of stratified random sampling of those aged from 25 to 50 years who lived in Tokyo and neighboring areas. Outcome variables were respondent health-care seeking attitudes toward their children's mild and severe symptoms of cold. Logistic regression models were developed for each dependent variable. A total of 1606 respondents with one or more children under the age of 15 years were included in the analysis. For mild symptoms of cold, no subsidy (OR: 0.51, 95%CI: 0.38-0.69) and partial subsidy (OR, 0.71; 95%CI: 0.54-0.95) were associated with fewer "visit on that day" answers, compared with full subsidy. Income and respondent educational level were not associated with the outcome. For severe symptoms of cold, the OR of no subsidy (0.61; 95%CI: 0.30-1.23) and that of partial subsidy (0.91; 95%CI: 0.40-2.07) were not statistically significant. Imposing a small copayment might prevent visits to medical facilities for mild symptoms of cold, but will not prevent visits for severe symptoms of cold.

Effects of a Universal Childcare Subsidy on Mothers’ Time Allocation

This paper examines the effects of a universal childcare subsidy on childcare decisions and mothers’ employment by using Korea’s policy reform of 2012, which provided a full childcare subsidy to all children aged 0 to 2. I find that the introduction of a universal childcare subsidy increased the use of childcare centers by children aged 0-2, which led to less maternal care compared to that provided to children aged 3-4. However, the expanded subsidy had little effect on mothers’ labor supply. Moreover, the policy effects vary by individual and household characteristics. The effects of the expanded subsidy are mainly found in low-income households and less educated mothers. Highly educated mothers and high-income households are likely to focus more on the quality of childcare service. These results imply that a simple reduction in childcare costs would bring only limited effects on mothers’ time allocation behavior; thus, more attention should be paid to improving the quality of childcare services.

Barriers to Skill Acquisition: Evidence from English Training in India

Skill development is increasingly viewed as a way to escape the low education – high unemployment trap in developing countries. Consequently, policy makers in these countries are extensively investing in skill development programs. However, participation and completion rates in many of these programs remains low. This paper investigates factors that prevent individuals from acquiring spoken English, an important skill with potentially high returns in the labor market. Using data from a field experiment in India that subsidizes the cost of learning spoken English, we find that full subsidy (compared to partial or no subsidy) positively effects the probability of participating in a spoken English training program. Conversely, distance to the training center, pre-existing knowledge of spoken English, and past enrollment in a similar course act as significant barriers to take-up. These findings suggest that multidimensional policy solutions are required to overcome the barriers to skill development in developing countries.

Safety Nets and Food Programs in Asia: A Comparative Perspective

Many countries adopted safety net programs to deal with the food crisis of 2008. However, such programs are often beset with targeting errors, inefficiencies, and fraud. Despite this, there is no systematic comparative analysis of safety nets. The objective of this paper is to identify generic issues germane to safety net design and their role in determining success. We examine the performance of safety net programs in Bangladesh, India, Indonesia, and the Philippines in terms of people covered, food distributed, and income support provided. These countries spend 1%-3% of their gross domestic product on safety nets — small in relation to developing and industrial economies. We find an across-the-board failure of targeting in the four countries. The reasons range from elite capture, incorrect identification of the poor, their lack of access, barriers to participation, and regional allocation biases. Even if perfect targeting could cover the entire target group and eliminate leakage to non-target groups, the target groups may not receive the full subsidy due to illegal diversions, operational inefficiencies, and excess costs of public agencies. The success of the safety nets will depend on increasing the participation of the poor and minimizing program waste. Computerization of supply chains to track grain supplies can reduce diversion, and switching from in-kind to cash transfers can cut administrative and other costs of physical handling. The mix of tools would depend upon the economic, political, cultural, and social backgrounds of the country, and its administrative and fiscal capabilities to provide safety net programs.

Evaluating China's biomass power production investment based on a policy benefit real options model

In this study, a policy benefit real options model was developed to evaluate biomass power production investment in China. A method based on the cumulative probability was proposed using binomial decision tree calculations for the exercising of options in order to evaluate the optimal investment timing. Two scenarios were analyzed to identify the optimal investment strategy with/without the consideration of revenue from certified emission reduction (CER). Uncertainties in straw purchased price, government incentives, and technological improvements were considered. The results showed that it was not optimal for immediate investment in biomass power production in China. Given full government subsidy, the thresholds of straw purchased price for scenarios 1 and 2 are 213.55 and 218.87 RMB/ton, respectively, while the current straw purchased price in Chinese market is 220 RMB/ton. The investment of biomass power production would be executed at 2022 and 2028 with/without the consideration of revenue from CER in the current situation in China if there are no government incentive to encourage motivation, respectively. The conclusion could provide useful information for power enterprise decision-makers on whether and when to invest a biomass power production in China in an uncertain environment.

A novel modeling based real option approach for CCS investment evaluation under multiple uncertainties

In this study, a trinomial tree modeling-based real option approach was developed to evaluate the investment in CCS retrofitting for two typical types of power plants from the perspective of power generation enterprises. A method based on the cumulative probability was proposed using trinomial decision tree calculations for the exercising of options in order to evaluate the optimal retrofit timing. Uncertainties in carbon prices, government incentives, annual running time, power plant lifetime, and technological improvements were considered. From the result, the cost saving effect of CCR pre-investment was apparent. When the current carbon price increased to 350.0RMB/ton CO2, a power plant with CCR pre-investment would execute CCS retrofitting immediately, while this value would have to increase to 371.8RMB/ton CO2 for the SC scenario. The two typical types of power plants were not optimal for immediate investment in CCS technology in the current market situation. Given a full government subsidy, the critical carbon prices for SC and SC+CCR were 239.2 and 230.0RMB/ton CO2, respectively, while the current carbon price in the voluntary emission reduction market was 3.5RMB/ton CO2. By introducing CO2 utilization technology, the critical carbon prices fell to 195.5 and 186.3RMB/ton CO2, but they were still not optimal for immediate investment. CCR pre-investment was conducive to CCS retrofitting deployment; this would be more significant when considering CO2 utilization technologies. The results indicated that a large gap existed between the carbon price needed for CCS retrofitting of both typical types of power plants and the current prices in the voluntary emission reduction market. Moreover, the results obtained could also provide useful information for the CCS policy-making of power enterprises in an uncertain environment.

Knowledge, Attitude, Practice and Barriers on Vaccination against Human Papillomavirus Infection: A Cross-Sectional Study among Primary Care Physicians in Hong Kong

This study explored the knowledge, attitude, practice and barriers to prescribe human papillomavirus (HPV) vaccines among private primary care physicians in Hong Kong. A self-administered questionnaire survey was conducted by sending letters to doctors who had joined a vaccination program for school girls. From 720 surveys sent, 444 (61.7%) completed questionnaires were returned and analyzed. For knowledge, few responded to questions accurately on the prevalence of cervical HPV (27.9%) and genital wart infection (13.1%) among sexually active young women in Hong Kong, and only 44.4% correctly answered the percentage of cervical cancers caused by HPV. For attitude, most agreed that HPV vaccination should be fully paid by the Government (68.3%) as an important public health strategy. Vaccination against HPV was perceived as more important than those for genital herpes (52.2%) and Chlamydia (50.1%) for adolescent health, and the majority selected adolescents aged 12–14 years as the ideal group for vaccination. Gardasil® (30.9%) and Cervarix® (28.0%) were almost equally preferred. For practice, the factors influencing the choice of vaccine included strength of vaccine protection (61.1%), long-lasting immunity (56.8%) and good antibody response (55.6%). The most significant barriers to prescribe HPV vaccines consisted of parental refusal due to safety concerns (48.2%), and their practice of advising vaccination was mostly affected by local Governmental recommendations (78.7%). A substantial proportion of physicians had recommended HPV vaccines for their female clients/patients aged 18–26 years for protection of cervical cancer (83.8%) or both cervical cancer and genital warts (85.5%). The knowledge on HPV infection was low among physicians in Hong Kong. Prescription of HPV vaccine was hindered by the perceived parental concerns and was mostly relied on Governmental recommendations. Educational initiatives should be targeted towards both physicians and parents, and the Government should consider full subsidy to enhance vaccine uptake rate.

The cost-effectiveness of laparoscopic adjustable gastric banding in the morbidly obese adult population of Australia.

BackgroundTo examine the cost-effectiveness of providing laparoscopic adjustable gastric banding (LAGB) surgery to all morbidly obese adults in the 2003 Australian population.Methods and FindingsAnalyzed costs and benefits associated with two intervention scenarios, one providing LAGB surgery to individuals with BMI >40 and another to individuals with BMI >35, with each compared relative to a ‘do nothing’ scenario. A multi-state, multiple cohort Markov model was used to determine the cost-effectiveness of LAGB surgery over the lifetime of each cohort. All costs and health outcomes were assessed from an Australian health sector perspective and were discounted using a 3% annual rate. Uncertainty and sensitivity analyzes were conducted to test the robustness of model outcomes. Incremental cost-effectiveness ratios (ICERs) were measured in 2003 Australian dollars per disability adjusted life year (DALY) averted.The ICER for the scenario providing LAGB surgery to all individuals with a BMI >40 was dominant [95% CI: dominant - $588] meaning that the intervention led to both improved health and cost savings. The ICER when providing surgery to those with a BMI >35 was $2 154/DALY averted [95% CI: dominant - $6 033]. Results were highly sensitive to changes in the likelihood of long-term complications.ConclusionLAGB surgery is highly cost-effective when compared to the $50 000/DALY threshold for cost-effectiveness used in Australia. LAGB surgery also ranks highly in terms of cost-effectiveness when compared to other population-level interventions for weight loss in Australia. The results of this study are in line with other economic evaluations on LAGB surgery. This study recommends that the Australian federal government provide a full subsidy for LAGB surgery to morbidly obese Australians with a BMI >40.

Universal health coverage in Rwanda: a report of innovations to increase enrolment in community-based health insurance

BackgroundRwanda's community-based health insurance programme (Mutuelle de Santé) has been the focus of several large studies and much debate in global health policy. Comprehensive insurance reform enacted in mid-2011 transformed Mutuelle de Santé to a system of tiered premiums to make it more financially progressive and sustainable. Many governments in sub-Saharan Africa and south Asia have studied Rwanda's approach, particularly mechanisms to achieve high coverage, which exceeded 90% by 2010. We assessed the effect of different community-based initiatives on Rwanda's progress towards universal health-care coverage and increased use of health services. MethodsWe reviewed Rwandan interventions developed for villages that have enabled the scale-up of Mutuelle de Santé. We reviewed data from the Ubudehe database (proportion of people in each wealth category across districts), the Community Based Health Insurance database (coverage across districts), the preliminary National Health Accounts 2009–10 (out-of-pocket spending as a proportion of total health expenditure), and the Demographic and Health Survey 2010 (contacts per year and out-of-pocket spending). FindingsOver the first decade, national Mutuelle de Santé covered more than 90% of the population, has reduced out-of-pocket spending for health from 28% to 12% of total health expenditure, and increased service use to 1·8 contacts per year. A wealth categorisation programme (Ubudehe) was originally developed as a basic community target scheme, and modified after the 1994 genocide to enrol the most vulnerable citizens into national social protection programmes. It was then adapted to enable communities to assess the socioeconomic status of each citizen to provide a more progressive tiered premium collection system that includes full subsidies for members of the two poorest sub-categories. Ubudehe ratings account for income, household assets, and ability to work and each person is assessed collectively by the members of their village. Additionally, local leaders and 45 000 community health-care workers were incentivised to support individual enrolment in Mutuelle de Santé by inclusion of district coverage levels as a key indicator in their performance-based financing scheme. Finally, a household cooperative savings mechanism (Ibimina), which was developed by one rural district, has spread throughout Rwanda, with several districts reporting that up to 40% of premiums are being fully pre-paid 3 months before the start of the next financial year. Districts that use Ibimina have reduced administrative costs for Mutuelle de Santé programme management, and increased participation in decision making by village residents. InterpretationAs universal health coverage becomes a global health priority, countries should learn from community-level interventions to break down both financial and geographical barriers to access. FundingNone.

A Randomized Pilot Trial of a Full Subsidy vs. a Partial Subsidy for Obesity Treatment

Intensive obesity treatment is mandated by federal health care reform but is costly. A partial subsidy for obesity treatment could lower the cost of treatment, without reducing its efficacy. This study sought to test whether a partial subsidy for obesity treatment would be feasible, as compared to a fully subsidized intervention. The study was a pilot randomized trial. Participants (n = 50) were primary care patients with obesity and at least one comorbid condition (diabetes, hypertension, dyslipidemia, or obstructive sleep apnea). Each participant received eight weight loss counseling visits as well as portion-controlled foods for weight loss. Participants were randomized to full subsidy or partial subsidy (2 vs. 1 meal per day provided). The primary outcome was weight change after 4 months. Secondary outcomes included changes in blood pressure, waist circumference, and health-related quality of life. Participants in the full and partial subsidy groups lost 5.9 and 5.3 kg, equivalent to 5.3% and 5.1% of initial weight, respectively (P = 0.71). Changes in secondary outcomes were similar in the two groups. A partial subsidy was feasible and induced a clinically similar amount of weight loss, compared to a full subsidy. Large-scale testing of economic incentives for weight control is merited given the federal mandate to offer weight loss counseling to obese patients.

Strategies for delivering insecticide-treated nets at scale for malaria control: a systematic review

To synthesize findings from recent studies of strategies to deliver insecticide-treated nets (ITNs) at scale in malaria-endemic areas. Databases were searched for studies published between January 2000 and December 2010 in which: subjects resided in areas with endemicity for Plasmodium falciparum and Plasmodium vivax malaria; ITN delivery at scale was evaluated; ITN ownership among households, receipt by pregnant women and/or use among children aged < 5 years was evaluated; and the study design was an individual or cluster-randomized controlled design, nonrandomized, quasi-experimental, before-and-after, interrupted time series or cross-sectional without temporal or geographical controls. Papers describing qualitative studies, case studies, process evaluations and cost-effectiveness studies linked to an eligible paper were also included. Study quality was assessed using the Cochrane risk of bias checklist and GRADE criteria. Important influences on scaling up were identified and assessed across delivery strategies. A total of 32 papers describing 20 African studies were reviewed. Many delivery strategies involved health sectors and retail outlets (partial subsidy), antenatal care clinics (full subsidy) and campaigns (full subsidy). Strategies achieving high ownership among households and use among children < 5 delivered ITNs free through campaigns. Costs were largely comparable across strategies; ITNs were the main cost. Cost-effectiveness estimates were most sensitive to the assumed net lifespan and leakage. Common barriers to delivery included cost, stock-outs and poor logistics. Common facilitators were staff training and supervision, cooperation across departments or ministries and stakeholder involvement. There is a broad taxonomy of strategies for delivering ITNs at scale.

Subsidising patient dispensing fees: The cost of injecting equity into the opioid pharmacotherapy maintenance system

Australian pharmacotherapy maintenance programs incur costs to patients. These dispensing fees represent a financial burden to patients and are inconsistent with Australian health-care principles. No previous work has examined the current costs nor the future predicted costs if government subsidised dispensing fees. A system dynamics model, which simulated the flow of patients into and out of methadone maintenance treatment, was developed. Costs were imputed from existing research data. The approach enabled simulation of possible behavioural responses to a fee subsidy (such as higher retention) and new estimates of costs were derived under such scenarios. Current modelled costs (AUS$11.73m per month) were largely borne by state/territory government (43%), with patients bearing one-third (33%) of the total costs and the Commonwealth one-quarter (24%). Assuming no behavioural changes associated with fee subsidies, the cost of subsidising the dispensing fees of Australian methadone patients would be $3.9m per month. If retention were improved as a result of fee subsidy, treatment numbers would increase and the model estimates an additional cost of $0.8m per month. If this was coupled with greater numbers entering treatment, the costs would increase by a further $0.4m per month. In total, full fee subsidy with modelled behavioural changes would increase per annum government expenditure by $81.8m to $175.8m. If government provided dispensing fee relief for methadone maintenance patients, it would be a costly exercise. However, these additional costs are offset by the social and health gains achieved from the methadone maintenance program.

DO SCHOOL LUNCH SUBSIDIES CHANGE THE DIETARY PATTERNS OF CHILDREN FROM LOW‐INCOME HOUSEHOLDS?

This article examines the effects of school lunch subsidies provided through the means‐tested component of the National School Lunch Program on the dietary patterns of children aged 10–13 years in the United States. Analyzing data on 5,140 public school children in fifth grade during spring 2004, we find significant increases in the number of servings of fruit, green salad, carrots, other vegetables, and 100% fruit juice consumed in 1 week for subsidized children relative to unsubsidized children. The effects on fruit and other vegetable consumption are stronger among the children receiving a full subsidy, as opposed to only a partial subsidy, and indicate the size of the subsidy is an important policy lever underlying the program's effectiveness. Overall, the findings provide the strongest empirical evidence to date that the means‐tested school lunch subsidies increase children's consumption over a time period longer than one school day. (JEL H51, I12, I38)

Crowding-out effect of the current food stamp subsidy scheme

We construct a model to illustrate that the current food stamp subsidy scheme fails to achieve its stated aim due to the crowding-out effect. More specifically, if the household income is sufficiently low, only a corner solution exists, and a full subsidy is needed.