Future Expenditures Research Articles

Business-Level Expectations and Uncertainty

The Census Bureau’s 2015 Management and Organizational Practices Survey (MOPS) utilized innovative methodology to collect five-point forecast distributions over own future shipments, employment, and capital and materials expenditures for 35,000 U.S. manufacturing plants. First and second moments of these plant-level forecast distributions covary strongly with first and second moments, respectively, of historical outcomes. The first moment of the distribution provides a measure of business’ expectations for future outcomes, while the second moment provides a measure of business’ subjective uncertainty over those outcomes. This subjective uncertainty measure correlates positively with financial risk measures. Drawing on the Annual Survey of Manufactures and the Census of Manufactures for the corresponding realizations, we find that subjective expectations are highly predictive of actual outcomes and, in fact, more predictive than statistical models fit to historical data. When respondents express greater subjective uncertainty about future outcomes at their plants, their forecasts are less accurate. However, managers supply overly precise forecast distributions in that implied confidence intervals for sales growth rates are much narrower than the distribution of actual outcomes. Finally, we develop evidence that greater use of predictive computing and structured management practices at the plant and a more decentralized decision-making process (across plants in the same firm) are associated with better forecast accuracy.

Specific Features Of Geological Risk Assessment In Moscow

The paper describes approaches to assessing geohazards and georisk of economic losses in Moscow. It is shown that for surface construction, the principle geohazards in Moscow are karst-suffosion sinkholes, land subsidence, landslides, and waterlogging. The subsurface construction is endangered by karstification and fracturing of limestone, decompaction, and swelling of clay, quicksand phenomena, and groundwater breakthrough to tunnels. The different procedures for the assessment of geological risk in Moscow have been suggested for already existing urban infrastructure and for future planned construction. For existing surface urban infrastructure, geological risk is considered to be an integral parameter of probable damage caused by geohazards and the anthropogenic load on the specific territories. The main aim of risk mapping in this case is outlining the territories, for which restrictions and prohibitions should be imposed for further urban engineering development. For future subsurface urban construction, the risk-analysis consists in assessing the impact of geohazards on the engineering structure by comparing the future expenditures for the construction and operation under different engineering geological conditions. The procedures of risk mapping elaborated for both approaches are described; the typification schemes are listed; and the relevant risk maps built for the Moscow territory are provided. The risk maps will help planners to compare and make alternative project decisions in order to minimize the cost in future economic expenditures. Both approaches are successfully approved in Moscow.

THE IMPACT OF FUNCTIONAL DISABILITY ON HOSPITALIZATION SPENDING IN SINGAPORE

Singapore is one of the fastest-aging populations due to increased life expectancy and lowered fertility. Lifestyle changes increase the burden of chronic diseases and disability. These have important implications for social protection systems. The goal of this paper is to model future functional disability and healthcare expenditures based on current trends. To project the health, disability and hospitalization spending of future elders, we adapted the Future Elderly Model (FEM) to Singapore. The FEM is a dynamic Markov microsimulation model developed in the US. Our main source of population data was the Singapore Chinese Health Study (SCHS) consisting of 63,000 respondents followed up over three waves from 1993 to 2010. The FEM model enables us to investigate the effects of disability compounded over the lifecycle and hospitalization spending, while adjusting for competing risk of multi-comorbidities. Results indicate that by 2050, 1 in 6 older adults will have at least one ADL disability and 1 in 3 older adults will have at least one IADL disability, an increase from 1 in 12 elders and 1 in 5 elders respectively in 2014. The highest prevalence of functional disability will be in those aged 85 years and above. Lifetime hospitalization spending of elders aged 55 and above is US$24,400 (30.2%) higher among people with functional disability compared to those without disability. Policies that successfully tackle diabetes and promote healthy living may reduce or delay the onset of disability, leading to potential saving. In addition, further technological improvements may reduce the financial burden of disability.

SPREMINJANJE IN RAZVOJ SLOVENSKE VOJSKE – POGLED IZ TUJINE

Abstract The Republic of Slovenia has been a member of NATO for 15 years. In preparing for NATO membership the Slovenian Armed Forces (SAF) were required to prepare for radical change, from a territorial defence force to one that could contribute to NATO missions. The need for change became even more significant after the government decision in 2002 to end conscription and move to a fully professional SAF. A revised force structure for the SAF was agreed in 2003, prior to Slovenia joining NATO in 2004. Progress in developing the SAF in the first five years of NATO membership, while encountering a number of challenges, showed a positive trend, with a commensurate increase in defence expenditure. In the following five years the economic crisis which affected most NATO countries had a particularly damaging effect on the continued development of the SAF, with very severe reductions in defence expenditure. Today, after 15 years of NATO membership, the SAF has still not recovered from the cuts made in defence spending. Spending remains close to 1.0% of GDP and is inadequate to support the force plans of the SAF. The SAF is unable to make an effective contribution to NATO and a decision needs to be made on the future size and shape of the SAF which matches plans for future defence expenditure. Key words NATO, Slovenia, Professionalization, Defence Planning, Defence Expenditure, Missions, Force Structure, Democratic Control.

NATO IN SLOVENIJA 15 LET POZNEJE: KAKO USPEŠNE SO BILE NAPOVEDI IZDATKOV ZA OBRAMBO

Abstract The financial consequences of NATO membership had been a subject of debate in the reasons for Slovenian accession to the Alliance before 2004. In order to provide projections of financial obligations and defence expenditure of a new NATO member, some authors and institutions had developed appropriate financial assessments. Based on an analysis of the available sources the authors of this article try to find out how accurate those projections were. They recognize objective circumstances responsible for more or less accurate projections, observing a higher quality of assessments about future defence expenditure than those dealing with financial contributions to NATO budget. Among other messages they call for attention in avoiding possible wrong conclusions that the actual reduction of defence budget that had happened in reality is not a consequence of NATO membership as some projected. Key words defence expenditure, financial contributions, NATO membership.

Empirical Design Method for Distribution Transformer Utilization Optimization

The increasing penetration of electric vehicles and distributed generation into distribution networks are giving rise to higher, more volatile, and bi-directional energy flows through distribution transformers (DTs). To minimize future capital expenditure, improved DT design approaches are required. Therefore, a novel DT design approach based on a new paradigm of “designing for maximum utilization” is proposed. It incorporates manufacturer and customer-sourced empirical data to achieve a desired DT retirement age and utilization rate, and allows for transient operation beyond DT nameplate rating through accurately accounting for thermal inertia. The novelty of the proposed approach derives from not only a new notion of designing for maximum utilization, but also allowing for the fact that winding insulation may not be the most critical factor affecting a DT's lifetime. Using the proposed approach, DT capital expenditure and utilization constraints can be optimized at a planning stage. The algorithm is applied and validated.

Volatility-of-Volatility Risk in the Crude Oil Market

Under the stochastic volatility-of-volatility framework, we show that oil volatility-of-volatility risk is a significant pricing factor for cross-sectional delta-hedged gains constructed from 1-month United States Oil Fund (USO) options, and is negatively priced. Moreover, oil volatility-of-volatility risk can significantly and negatively predict one-period ahead delta-hedged option gains. The findings are robust after implementing several tests such as controlling for jump risk measures, another measure of oil volatility-of-volatility and delta-hedged gains constructed from 1-week USO options. The information content of oil volatility-of-volatility is also distinctive from its equity counterpart, which can contribute to predicting the future real personal consumption expenditure.

University education: a potential health promotion intervention for Australian baby boomers

ABSTRACTIt is forecast that ageing baby boomers will have a substantial impact on future health expenditure. The primary aim of this study is to explore the perceived health benefits of later life university study for baby boomers. An online survey of Australian baby boomers examined their beliefs regarding the health benefits of studying at university in later life and related barriers. Data from 261 respondents revealed the main benefits to be gained from later life university study were improved critical thinking and decision-making skills. The main motivators were personal fulfilment and mental or intellectual stimulation, and financial cost the most important barrier. The results from this study suggest that university study in later life should be considered as a health promotion intervention for older adults seeking mental/intellectual stimulation. Enhancement of cognitive function through such interventions may have significant positive impacts on health outcomes across short, medium and long-term timeframes.

MODERN APPROACHES TO MANAGING FINANCIAL RESOURCES IN UKRAINE’S HEALTH PROTECTION BODIES

The process of financing health care institutions which has gained considerable importance in the field of health care of Ukraine has been investigated. Positive and negative aspects of this process have been identified, the current legislation on the mechanism of financial security regulation has been analyzed and the focuse has been made on the most problematic issues of the primary financing (medical-sanitary), secondary (specialized), tertiary (highly specialized) medical care.The urgency of the management of financial resources of health care institutions in the conditions of implementation medical reform in Ukraine has been proved. The structure of revenues to health care institutions by sources of financing has been analyzed and peculiarities of implementation of the modern model of their financing have been revealed. The necessity of revision of the nature of financial relations and the formation of new requirements for the management of financial resources in the sphere of financing of health care institutions in Ukraine has been established. The characteristic features of financial resources in health care institutions are substantiated and their definition has been proposed. The role of financial flows in shaping current and future incomes and expenditures of health care institutions has been revealed, the necessity of introduction of new methods of financial management has been proved. The classification of financial resources and financial flows in health care institutions has been formed. A modern approach to the management of financial resources in health care based on the disclosure of financial flow parameters and the idea of ordering for different kinds of medical services establishments is proposed. It was determined that the optimality of the formed model of financial resources management is possible on the assumption that the financial flows parameters are evaluated in the appropriate time interval in the form of the types of medical services. It is established that the state and prospects of development of health care institutions are determined by the ability to function effectively under conditions of managerial and financial autonomy taking into account the requirements of the institutional society.

National trends in prescription drug expenditures and projections for 2019

Historical trends and factors likely to influence future pharmaceutical expenditures are discussed, and projections are made for drug spending in 2019 in nonfederal hospitals, clinics, and overall (all sectors). Drug expenditure data through calendar year 2018 were obtained from the IQVIA National Sales Perspectives database and analyzed. New drug approvals, patent expirations, and other factors that may influence drug spending in hospitals and clinics in 2019 were also reviewed. Expenditure projections for 2019 for nonfederal hospitals, clinics, and overall (all sectors) were made through a combination of quantitative analyses and expert opinion. U.S. prescription sales in calendar year 2018 totaled $476.2 billion, a 5.5% increase from 2017 spending. The top 3 drugs by expenditures were adalimumab ($19.1 billion), insulin glargine ($9.3 billion), and etanercept ($8.0 billion). Prescription expenditures in nonfederal hospitals totaled $35.8 billion, a 4.8% increase from 2017. Expenditures in clinics in 2018 increased by 13.0% to $80.5 billion. The increase in spending in nonfederal hospitals was largely driven by new products and increased utilization of existing products. The list of the top 25 drugs by expenditures in nonfederal hospitals and clinics was dominated by specialty drugs. We predict continued moderate growth of 4-6% in overall drug expenditures (across the entire U.S. market). We expect the clinic sector to continue to experience high (11-13%) growth in drug spending in 2019. Finally, for nonfederal hospitals we anticipate growth in the range of 3-5%. These estimates are at the national level. Health-system pharmacy leaders should carefully examine local drug utilization patterns to determine their own organization's anticipated spending in 2019.

Clinical risk groups and patient complexity: a case study with a primary care clinic in Alberta

Complexity and risk adjustment are two strategies employed to understand chronic disease and healthcare cost within patient populations. There is a general assumption that the data applied to risk adjustment models, such as the clinical risk groups (CRG) is sufficient to infer patient complexity. Our aim in this study was to compare the calculated complexity of a patient population using the 3 M™ CRG software to complexity data extracted from community-based primary care electronic medical records (EMR). We found that the distribution of the 3 M™ CRG health status was significantly different from the primary care EMR health status distribution, and that the number and type of chronic conditions identified differed between the two methods. We calculated a new variable that combined the information from the 3 M™ CRG software with the primary care EMR data. The distribution of the Combined-CRG distribution was significantly different from the 3 M™ CRG software; specifically, we saw many patients originally classified as being healthy or having minor chronic condition(s) re-categorized into having significant chronic condition(s). The CRG health statuses alone may be sufficient to predict future health expenditures, but caution is warranted if CRGs are to be used to infer complexity of the patient population.

The Long-Term Impact of Functional Disability on Hospitalization Spending in Singapore.

Singapore is one of the fastest-aging populations due to increased life expectancy and lowered fertility. Lifestyle changes increase the burden of chronic diseases and disability. These have important implications for social protection systems. The goal of this paper is to model future functional disability and healthcare expenditures based on current trends. To project the health, disability and hospitalization spending of future elders, we adapted the Future Elderly Model (FEM) to Singapore. The FEM is a dynamic Markov microsimulation model developed in the US. Our main source of population data was the Singapore Chinese Health Study (SCHS) consisting of 63,000 respondents followed up over three waves from 1993 to 2010. The FEM model enables us to investigate the effects of disability compounded over the lifecycle and hospitalization spending, while adjusting for competing risk of multi-comorbidities. Results indicate that by 2050, 1 in 6 elders in Singapore will have at least one ADL disability and 1 in 3 elders will have at least one IADL disability, an increase from 1 in 12 elders and 1 in 5 elders respectively in 2014. The highest prevalence of functional disability will be in those aged 85 years and above. Lifetime hospitalization spending of elders aged 55 and above is US$24,400 (30.2%) higher among people with functional disability compared to those without disability. Policies that successfully tackle diabetes and promote healthy living may reduce or delay the onset of disability, leading to potential saving. In addition, further technological improvements may reduce the financial burden of disability.

Формирование условий для проведения обзоров расходов в России

The article is focused on implementation of spending reviews in Russia. The authors claim that general success of spending reviews in the country depends on certain institutional conditions. Adoption of the order of the Russian Government on the approval of the spending reviews format is viewed by the authors as one of the necessary steps that should be followed by adoption of the regulations and guides set. In particular, operational procedures of working groups should be approved, preparation standards for final reports should be set, leading role of the Ministry of Finance in operational management should be outlined as well as roles and responsibilities of all other stakeholders. Based on the experience of OECD countries, the article states that special information base of spending reviews is also required. It should be different from the base used in programs and project evaluation process because of different purposes of spending reviews and program efficiency evaluation: success of spending review means that proposals for future expenditures reallocation are integrated into the budget process (which is usually not the case with program efficiency evaluation). The authors conclude that implementation of spending reviews should become a part of integrated approach in governance of budget expenditures in Russia, complementing such performance budgeting instruments as project/program effectiveness and efficiency evaluation, monitoring of financial management quality and efficiency auditing.

Забезпечення майбутніх витрат і платежів: методичні аспекти вдосконалення облікового відображення

Забезпечення майбутніх витрат і платежів: методичні аспекти вдосконалення облікового відображення

Local Government Financing of Climate Change in Ghana: Politics of Aid and Central Government Dependency Syndrome

Uncertainties about the amount of resources needed to combat climate change, dwindling local resources, limited local autonomy and limited expertise constrain local governments (LGs) in their response to the effects of climate change. As a result, financing climate change remains a major nightmare for LG actors across diverse nested territorial containers. It certainly requires the embracing of a multifaceted approach – the use of system thinking where local governments’ resource husbandry is optimised to support external aid and central government transfer. A multifaceted approach brings onboard blended resources, diverse stakeholders, diverse resource mobilisation skills and schemes, and accountability measures. Also, given projected increases in future climate-induced public expenditure, albeit with uncertainties, reliance on a single resource mobilisation approach will be a recipe for inefficiency. This article argues that developmental aid and central government’s transfer remains inadequate to meet the increasing demand for adaptation cost at the local level in Ghana. In the face of the unequivocal impact of climate change risk, we contend that local resource husbandry must be optimised through different innovations to complement other major sources of financing. Our contention resonates with the school of thought that argues local level resources are more resilient to politicisation, are stable, and are predictable compared to international aid and central government transfer. Through qualitative in-depth interviews, empirical data has been drawn from local governments in Ghana to justify our claims.

Investment expenditures in Ukrainian agricultural enterprises: prognosis and development of appropriate investment strategy

Increasing the level of innovation and investment support for agricultural enterprises is particularly relevant. This enables them to function effectively in a dynamic, open environment. Thus, the main purpose of the paper is to characterize the current state and sources of investment expenditures in agricultural enterprises in Ukraine, and to make predictions on the inflow of investments in the agricultural sector in the future. Basing of this prognosis the recommendation of the appropriate steps towards investment strategy development in farming firms was formulated. ARIMA forecasting method was used in the article to determine the future expenditures for investments in Ukrainian agricultural sector. It was observed that there has been an inflow of investments in the area of Ukrainian agriculture in recent years. Additionally it was forecasted that this growth will continue in the future. Different scenarios tested showed an increase from 11 to 30% in 2019. Additionally companies could attract and utilize the FDI funds, which unfortunately decreased during the period 2015-2017 in agricultural sector. It could be however expected that these trend will revert together with changing political and economic situation of Ukraine, and companies could use this resources for their development.

Economic Impact of Financial Incentives and Mailing Nicotine Patches to Help Medicaid Smokers Quit Smoking: A Cost–Benefit Analysis

An RCT designed to increase Medicaid smokers' quitting success was conducted in California during 2012-2013. In the trial, alternative cessation treatment strategies were embedded in the state's ongoing quitline services. It found that modest financial incentives of up to $60 per participant and sending nicotine patches induced significantly higher cessation rates compared with usual care alone and usual care plus nicotine patches. Building upon that study, this study assessed potential population-level costs and benefits of integrating financial incentives and nicotine patches in a quitline setting for Medicaid smokers. A cost-benefit analysis was undertaken from the Medicaid program's perspective. The Cardiovascular Disease Policy Model was used to simulate future healthcare expenditures over a 10-year horizon for each treatment strategy for a study cohort of California Medicaid enrollees who were aged 35-64 years in 2014 (n=2,452,000). To simulate potential population-level benefits under each treatment strategy, each treatment was applied to all active smokers in the study cohort (n=478,300). Sensitivity analyses were conducted by varying key parameters, such as cessation costs, discount rate, relapse rates, and time horizon. Adding both financial incentives and nicotine patches to usual quitline care would result in $15 million net savings over 10 years, with a benefit-cost ratio of 1.30 compared with the usual care plus nicotine patches strategy. It would yield $44 million net savings, with a benefit-cost ratio of 1.90 compared with usual care alone. The strategy of providing financial incentives and mailing nicotine patches directly to Medicaid smokers who call the quitline is cost saving. SUPPLEMENT INFORMATION: This article is part of a supplement entitled Advancing Smoking Cessation in California's Medicaid Population, which is sponsored by the California Department of Public Health.

Machine learning approaches for predicting high cost high need patient expenditures in health care

BackgroundThis paper studies the temporal consistency of health care expenditures in a large state Medicaid program. Predictive machine learning models were used to forecast the expenditures, especially for the high-cost, high-need (HCHN) patients.ResultsWe systematically tests temporal correlation of patient-level health care expenditures in both the short and long terms. The results suggest that medical expenditures are significantly correlated over multiple periods. Our work demonstrates a prevalent and strong temporal correlation and shows promise for predicting future health care expenditures using machine learning. Temporal correlation is stronger in HCHN patients and their expenditures can be better predicted. Including more past periods is beneficial for better predictive performance.ConclusionsThis study shows that there is significant temporal correlation in health care expenditures. Machine learning models can help to accurately forecast the expenditures. These results could advance the field toward precise preventive care to lower overall health care costs and deliver care more efficiently.

Prevalence of Non-Alcoholic Fatty Liver Disease (NAFLD) and Non-Alcoholic Steatohepatitis (NASH) in High-Risk Undiagnosed Adults in South Florida

Introduction: Non-alcoholic fatty liver disease (NAFLD) is reportedly increasing in prevalence. Purportedly, 3-5% of NAFLD patients will progress to non-alcoholic steatohepatitis (NASH). The prevalence of NAFLD and NASH among high-risk adults reportedly ranges from 20-25% and 3-12% respectively. This study aims to investigate a more precise prevalence of NAFLD and NASH among undiagnosed high-risk individuals in South Florida by utilizing FibroScan®, a non-invasive assessment of transient elastography and controlled attenuation parameter (CAP). Methods: This is a cross-sectional analysis of 51 patients who met ≥2 inclusion criteria: BMI ≥30 kg/m2, waist circumference >40” in men and >35” in women, HTN, hypertriglyceridemia and DM II. All patients who met the inclusion criteria underwent FibroScan® imaging. Two measures were obtained: CAP and kilopascals (kPa), metrics for steatosis and fibrosis respectively. Prespecified, validated cutpoints for steatosis and fibrosis were CAP >280 and kPa >8. An analysis of variant (ANOVA) was conducted to explore the impact of each patient's total risk factors on CAP score. Results: Of 51 patients, 21 males and 13 females had a CAP ≥280. 3 males had a kPa ≥8. Among this cohort, the mean CAP and kPa were 330.29 and 8.50 respectively. A t-test disclosed no significant difference in CAP score between males and females (p=0.235). The ANOVA revealed a statistical difference in CAP score in patients with 2 risk factors vs those with >2 risk factors (p=0.001) as noted in Fig. 2, demonstrating that additional risk factors may augment the development of steatosis.893_B Figure 2. Number of risk factors vs the mean CAP scoreConclusion: The diagnosis of NAFLD or NASH is often delayed in high risk patients, perhaps a consequence of the absence of an FDA approved therapeutic. FibroScan® is a screening tool with which patients can be assessed for subclinical disease. Our study demonstrates a much higher than reported prevalence of underlying NAFLD or NASH in the at-risk population. 67% of people with ≥2 risk factors for NASH and NAFLD had evidence of disease on FibroScan®. Thus, the current estimates for NASH and NAFLD may misjudge their prevalence in the US population. Moreover, a significant rise in CAP score was associated with more risk factors. Future healthcare expenditures for liver disease may therefore be higher than anticipated. Novel therapeutics for these disorders require greater attention in order to avert a potential hepatic disease ‘epidemic.'893_A Figure 1. Distribution of risk factors for NAFLD and NASH among males and females

Estimating the future health and aged care expenditure in Australia with changes in morbidity

AimsWe estimate the pure effect of ageing on total health and aged care expenditure in Australia in the next 20 years.MethodsWe use a simple demographic projection model for the number of people in older age groups along with a needs based estimate of changes in the public and private cost of care per person in each group adjusted for expected changes in morbidity.ResultsA pure ageing model of expenditure growth predicts an increase in health expenditure per elderly person from $7439 in 2015 to $9594 in 2035 and an increase in total expenditure from $166 billion to $320 billion (an average annual growth of 3.33%). If people live longer without additional morbidity, then total health expenditure only grows at an average annual rate of 0.48%. If only some of those additional years are in good health, then the average year on year growth is 1.87%.ConclusionAgeing will have a direct effect on the growth of health spending but is likely to be dwarfed by other demand and supply factors. A focus on greater efficiency in health production and finance is likely to be more effective in delivering high quality care than trying to restrain the demand for health and aged care among the elderly.