Future Spending Research Articles

Effects of a New York Medicaid Care Management Program on Substance Use Disorder Treatment Services and Medicaid Spending: Implications for Defining the Target Population.

Aims:We examined the effects of a statewide New York (NY) care management (CM) program for substance use disorder (SUD), Managed Addiction Treatment Services (MATS), on SUD treatment services’ utilization and spending among patients with a recent history of high Medicaid spending and among those for whom a predictive algorithm indicates a higher probability of outlier spending in the following year.Methods:We applied difference-in-difference analyses with propensity score matching using NY Medicaid claims data and a state registry of SUD-treatment episodes from 2006 to 2009. A total of 1263 CM enrollees with high SUD treatment spending (>$10K) in the prior year and a matched comparison group were included in the analysis. Crisis care utilization for SUD (detoxification and hospitalizations), outpatient SUD treatment, and Medicaid spending were examined over 12 months among both groups. CM effects among predicted high-future-spending patients (HFS) were also analyzed.Results:CM increased outpatient SUD treatment visits by approximately 10.5 days (95% CI = 0.9, 20.0). CM crisis care and spending outcomes were not statistically different from comparison since both conditions had comparable pre-post declines. Conversely, CM significantly reduced SUD treatment spending by approximately $955 (95% CI = −1518, −391) and reduced days of detox utilization by about 1.0 days (95% CI = −1.9, −0.1) among HFS.Conclusion:Findings suggest that CM can reduce SUD treatment spending and utilization when targeted at patients with a greater likelihood of high future spending, indicating the potential value of predictive models to select CM patients.

Projected private hospital expenditure in Ireland, 2018-2035: What role for demographics, cost, and Sláintecare?

Despite private hospitals occupying an important role in the delivery of acute hospital care in Ireland, an understanding of future spending pressures on these services is limited. Particularly, a key dimension of Ireland's ambitious roadmap for healthcare reform (Sláintecare) seeks to remove private practice from public hospitals. However, to date, there has been no examination of how this reform could impact private hospital demand and expenditure, and ultimately, the capacity to treat public patients. Using previously unavailable administrative health insurer data and a healthcare macro-simulation projection model, we project real (volume-based) and nominal expenditure on private hospital services over the medium-term (2018-2035). We develop a number of projection scenarios that vary assumptions in relation to population growth and ageing, healthy ageing, and the future cost of care delivery. Additionally, by developing profiles of private activity in public hospitals, we examine how the removal of private practice from public hospitals could impact on demand and expenditure in private hospitals over time. Findings from this analysis have implications for capital investment and workforce planning in private hospitals, and failure to meet future demand could have implications for access to care in public hospitals. Moreover, should private practice be ended in public hospitals, most complex private in-patient and emergency care is likely to remain within the public hospitals with limited capacity benefits for the public system.

Public investment multipliers: Evidence from stock returns of the road pavement industry in Japan

This study contributes empirical evidence of the macroeconomic impacts of public investment. I extract public investment news shocks from the excess returns of narrowly defined road pavement firms and use them as an instrument for future public investment spending. Using Japanese data for the period between 1980 and 2014, I find that when the news shock is followed by a persistent increase in public investment and a weak real interest rate response, the public investment spending has a significant stimulative effect over the medium term. The estimated cumulative multiplier is as large as 6.10, four years after the shock. However, the cumulative multiplier eventually falls below 1 after 10 years. I also report a substantial temporary improvement in aggregate labor productivity associated with a rise in public investment spending.

Tracking development assistance for health and for COVID-19: a review of development assistance, government, out-of-pocket, and other private spending on health for 204 countries and territories, 1990–2050

SummaryBackgroundThe rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020.MethodsWe estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$ per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050.FindingsIn 2019, health spending globally reached $8·8 trillion (95% uncertainty interval [UI] 8·7–8·8) or $1132 (1119–1143) per person. Spending on health varied within and across income groups and geographical regions. Of this total, $40·4 billion (0·5%, 95% UI 0·5–0·5) was development assistance for health provided to low-income and middle-income countries, which made up 24·6% (UI 24·0–25·1) of total spending in low-income countries. We estimate that $54·8 billion in development assistance for health was disbursed in 2020. Of this, $13·7 billion was targeted toward the COVID-19 health response. $12·3 billion was newly committed and $1·4 billion was repurposed from existing health projects. $3·1 billion (22·4%) of the funds focused on country-level coordination and $2·4 billion (17·9%) was for supply chain and logistics. Only $714·4 million (7·7%) of COVID-19 development assistance for health went to Latin America, despite this region reporting 34·3% of total recorded COVID-19 deaths in low-income or middle-income countries in 2020. Spending on health is expected to rise to $1519 (1448–1591) per person in 2050, although spending across countries is expected to remain varied.InterpretationGlobal health spending is expected to continue to grow, but remain unequally distributed between countries. We estimate that development organisations substantially increased the amount of development assistance for health provided in 2020. Continued efforts are needed to raise sufficient resources to mitigate the pandemic for the most vulnerable, and to help curtail the pandemic for all.FundingBill & Melinda Gates Foundation.

Information Search and Product Returns Across Mobile and Traditional Online Channels

Product returns will soon cost firms a trillion dollars annually; e-commerce appears more at risk for these costs relative to offline channels. Retailers thus need strategic insights into which factors increase customers’ return propensity and when the short-term costs of returns might be offset by future customer purchases. This article reports two studies that use transaction data from two large apparel e-tailers. Study 1 demonstrates that due to the differences between mobile and traditional online channels, consumers form a larger consideration set when they shop through mobile channels, and this distinctive search practice spills over onto return rates. That is, return rates are lower in mobile channels, and the use of the mobile channel also alters the effect of discount promotions. The findings in Study 2 suggest that future purchases by consumers, after a return, are contingent on category characteristics. In categories in which customers can easily learn from their previous return experience, product returns positively increase future spending, but the opposite is true in categories in which it is difficult to learn.

Concentration and Persistence of Healthcare Spending: Evidence from China

One way to reduce healthcare costs is to target the high spenders who remain persistently high in cost over time. Using claims data from China between 2010 to 2014, we sought to identify the level of concentration in spending and the proportion of spenders whose costs remain high over five years. Using a transition matrix and a linear regression strategy, we find that the top 10% of the spenders account for more than 50% of total expenditures. Of the individuals who were in the top 10% in 2010, 33.6% remained in the top 10% one year later and 23.6% were still in that category even four years later. Past spending plays a major role in the dynamic of health spending. A 10% increase in expenditure is associated with an increase of 0.36% to 1.33% of spending in the future. Persistence has some heterogeneity in terms of age, gender, and income level. Many diseases have strong predictive power for future spending. Research on the concentration and persistence of health expenditures will inform policymakers in terms of controlling costs and providing protection for catastrophic spending.

Current and future flood risk of new build homes across different socio-economic neighbourhoods in England and Wales

Despite improvements in the management of flood risk and the introduction of new regulations, losses from flooding remain high. An important driver is the continuation of new assets being built in flood prone locations. Over the last decade over 120 000 new homes in England and Wales have been built in flood prone areas. While the yearly rates of new homes in flood risk areas have increased only moderately on the national level, significant differences between and within regions as well as between different flood types exist. Using property level data on new homes built over the last decade and information on the socio-economic development of neighbourhoods, we analyse spatial clusters of disproportional increase in flood exposure from recently built homes and investigate how these patterns evolve under different future climate scenarios. We find that a disproportionately higher number of homes built in struggling or declining neighbourhoods between 2008 and 2018 is expected to end up in areas at a high risk of flooding over their lifetime as a result of climate change. Based on these findings, we discuss issues regarding future spending on flood defences, affordability of private level flood protection and insurance as well as the role of spatial planning for adaptation in the face of climate change.

National trends in prescription drug expenditures and projections for 2021.

PurposeTo report historical patterns of pharmaceutical expenditures, to identify factors that may influence future spending, and to predict growth in drug spending in 2021 in the United States, with a focus on the nonfederal hospital and clinic sectors.MethodsHistorical patterns were assessed by examining data on drug purchases from manufacturers using the IQVIA National Sales Perspectives database. Factors that may influence drug spending in hospitals and clinics in 2021 were reviewed—including new drug approvals, patent expirations, and potential new policies or legislation. Focused analyses were conducted for biosimilars, cancer drugs, generics, coronavirus disease 2019 (COVID-19) pandemic influence, and specialty drugs. For nonfederal hospitals, clinics, and overall (all sectors), estimates of growth of pharmaceutical expenditures in 2021 were based on a combination of quantitative analyses and expert opinion.ResultsIn 2020, overall pharmaceutical expenditures in the United States grew 4.9% compared to 2019, for a total of $535.3 billion. Utilization (a 2.9% increase) and new drugs (a 1.8% increase) drove this increase, with price changes having minimal influence (a 0.3% increase). Adalimumab was the top drug in 2020, followed by apixaban and insulin glargine. Drug expenditures were $35.3 billion (a 4.6% decrease) and $98.4 billion (an 8.1% increase) in nonfederal hospitals and clinics, respectively. In clinics, growth was driven by new products and increased utilization, whereas in hospitals the decrease in expenditures was driven by reduced utilization. Several new drugs that will influence spending are expected to be approved in 2021. Specialty and cancer drugs will continue to drive expenditures along with the evolution of the COVID-19 pandemic.ConclusionFor 2021, we expect overall prescription drug spending to rise by 4% to 6%, whereas in clinics and hospitals we anticipate increases of 7% to 9% and 3% to 5%, respectively, compared to 2020. These national estimates of future pharmaceutical expenditure growth may not be representative of any particular health system because of the myriad of local factors that influence actual spending.

The cost of self-forgiveness: Incremental theorists spent more money after forgiving the self for past overspending

Self-forgiveness is typically understood as a process that prevents continued engagement in negative behavior. However, it can also have a dark side in that it can lead to continuing that negative behavior. In the current research, we examined self-forgiveness in the domain of overspending—a potentially self-harming behavior. We tested whether self-forgiveness for past overspending affected future spending as a function of individual differences in incremental theories about character. In two studies, we asked participants to recall a past overspending incident as well as the degree to which they forgive themselves for this overspending, and then assessed their spending during a grocery trip immediately afterwards (Study 1) or a shopping trip in the subsequent days (Study 2). In both studies, self-forgiveness for overspending was related to greater subsequent spending among incremental theorists, but not among entity theorists. These results extend current research on self-forgiveness by demonstrating that implicit theories can determine for whom self-forgiveness fosters positive behavioral change (entity theorists) and for whom self-forgiveness may maintain the self-harming behavior (incremental theorists).

The Impact of Anxiety on Perceptions During the Lockdown of COVID-19

The world faced a new way of organizing everyday life in many countries during 2019. Lockdowns applied in many societies. People adopted a “new way” of living which now is called “the new normal”. The tense days spent under the virus threat made people experience changes in their daily lives, plus it forced them into behaving differently than before when the fear of any pandemic was almost nonexistent. This research was conducted during the days of lockdown and it indicates the feelings people experienced during the conditions of lockdown, in particular: on the magnitude of anxiety they felt, how anxiety may have affected perceptions and behaviors related to economy; furthermore, on the perceptions of economic crisis. Also gender differences were tested regarding the above. An online survey was conducted in Albania from March 22nd to April 4th, 2020, during the lockdown period of COVID-19. Since the 9th of March 2020, the Albanian government started issuing the anti-COVID-19 measures that were toughened later in the following weeks of March and April. The education institutions were closed and other public and private services were limited. The government issued a strict curfew allowing people to go out in limited hours, in some days up to one hour. Some weekends the curfew lasted for 24-48 hours in isolation where citizens were prohibited to walk outside of their homes. Transportation was limited to the employee shuttles and distribution transportation services only. Private cars were not allowed for many weeks. Physical stores were closed; only those selling food could open for limited hours. 1205 respondents participated in this online survey, from which 1061 valid questionnaires were analyzed, in a sample of 66.2% female and 33.8% male, providing data regarding their feelings during quarantine, their decisions related to future spending and how they perceived the future economic situation. The aim is to investigate the relation between anxiety and economic crises perceptions, the levels of anxiety and decision-makings on future spending and if there is any variance affected by gender, in order to have an outcome on the assumption that anxiety feelings may affect peoples’ behavior as consumers. The results of this research show that there are differences between male and female groups on the levels of anxiety experienced during the lockdown and on the level of perception of future economic crisis, but there is no difference between gender groups regarding the decision in reducing future spending. Another finding from this research is that people experiencing high levels of anxiety, were more likely to lessen their future expenses. Also, there is a significant relationship between anxiety and the level of perception on the fear of future economic crisis in the country. People with high levels of anxiety, perceive a higher level of crisis. There is a significant relationship between anxiety and decision-making of reducing the future spending. People with high levels of anxiety, have higher levels of reduction of future spending. The decreasing of future spending is related more to the perception of future economic crisis than to feelings of anxiety.

PENGARUH RASIO LIKUIDITAS, SOLVABILITAS, AKTIVITAS, DAN PROFITABILITAS TERHADAP INVESTMENT OPPORTUNITY SET (Studi Empiris Pada Perusahaan Manufaktur Yang Terdaftar di Bursa Efek Indonesia Periode 2014-2018)

he growth of the company is an expectation desired by all parties, either by internal parties (boardof commissioners, board of directors, staff, etc.) or external parties (investors or creditors). One ofthe parameters used to determine future investments in the Investment Opportunity Set. InvestmentOpportunity Set describes the breadth of investment opportunities for a company but is highlydependent on the company's future spending options. This study was conducted to provide empiricalevidence whether the financial ratio of liquidity, solvency, activity, and profitability affectsthe Investment Opportunity Set.The population of this study is a manufacturing company listed on the Indonesia Stock Exchangewith observations from 2014 to 2018. Determination of samples using purposive samplingmethod, which is a sampling technique with certain considerations that are considered to providebetter data. The data used is sourced from the company's financial statements which can beaccessed through www.IDX.co.id and www.idnfinancials.com. The number of samples used in thisstudy was as many as 120 samples. The analysis technique used is multiple regression to obtain acomplete picture of the relationship between variables. This study used an α value of 5%. Based onthe results, the ratio of liquidity, solvency, and activity have influenced the InvestmentOpportunity Set with significance values of 0.009, 0.018, and 0.002, respectively. While theprofitability ratio does not affect the Investment Opportunity Set due to the value of significanceowned by 0.198.

Echoes of rising tuition in students’ borrowing, educational attainment, and homeownership in post-recession America

State public college tuition and fees have risen sharply in recent decades. In this paper we investigate how young Americans absorbed this increase and how it affected their post-schooling financial behaviors. Exploiting state-cohort variation in tuition increases, we find that recent student cohorts accommodated tuition shocks not by forgoing college education, but instead by amassing more debt. The rise in tuition and student debt in turn contributed to a sharp decline in homeownership which was concentrated in suburban and urban areas, especially in the US Northeast and West, and in higher-priced housing markets and locations in which younger adults make up a bigger share of the residential population. Thus tuition-hiking states can expect to see a response not through a decline in workforce skills, but through weaker future spending and wealth accumulation among young consumers.

A intenção de prevenção e de gastos futuros durante a COVID-19: um estudo considerando a tomada de decisões sob risco

Objetivo: O objetivo principal do estudo foi analisar os aspectos que influenciam na intenção de se prevenir de Covid-19, o objetivo secundário foi analisar a influência da intenção de se prevenir de Covid-19 na intenção de gastos futuros.Método: Para testar o modelo proposto, foi feito um levantamento com 402 pessoas. O modelo foi analisado por meio de Modelagem de Equações Estruturais baseada em variâncias (PLS-SEM).Originalidade/Relevância: Um modelo foi proposto, testado e validado para analisar a intenção de se prevenir de Covid-19.Resultados: Os resultados indicam que 49,4% da variância da intenção de se prevenir de Covid-19 é explicada pelo modelo proposto, sendo gravidade percebida e norma subjetiva antecessores de crença de autoeficácia (R2=0,326), que por sua vez é antecessor da intenção de se prevenir de Covid-19. Ademais, observou-se uma leve influência da gravidade percebida na intenção de gastos futuros (R2=0,008; β = 0,104; p 0,01).Contribuições teóricas: As principais contribuições deste estudo foram: identificar um modelo com relevante capacidade explicativa da intenção de se prevenir da Covid-19; demonstrar novas relações entre construtos ainda não testados na literatura, especificamente a influência da norma subjetiva na crença de autoeficácia e desta na intenção de gastos futuros; e demonstrar que alguns aspectos sociodemográficos influenciam a gravidade percebida, a crença de autoeficácia e a intenção de se prevenir de Covid-19.

The improving sequence effect on monetary sequences

Experimental studies reveal a preference for improving income sequences, challenging the axioms of the discounted utility model, such as the present value maximization principle. Through an experiment, we test the existence of this anomaly on short and long-term income sequences, by confirming previous experimental evidence. Although the participants are aware of the present value maximization, they select improving sequences of income mainly to cover their future spending needs, to feel motivation at work, and to receive a signal of success and status. In order to include this sequence effect in a mathematical valuation model, we propose an alternative model to value sequences which outperforms the traditional discounting model by fitting the present value with the preferences of the participants.

The Social Value of Improvement in Activities of Daily Living among the Advanced Parkinson's Disease Population.

Quantify the value of functional status (FS) improvements consistent in magnitude with improvements due to levodopa-carbidopa intestinal gel (LCIG) treatment, among the advanced Parkinson's disease (APD) population. The Health Economic Medical Innovation Simulation (THEMIS), a microsimulation that estimates future health conditions and medical spending, was used to quantify the health and cost burden of disability among the APD population, and the value of quality-adjusted life-years gained from FS improvement due to LCIG treatment compared to standard of care (SoC). A US-representative Parkinson's disease (PD)-comparable cohort was constructed in THEMIS based on observed PD patient characteristics in a nationally representative dataset. APD was defined from the literature and clinical expert input. The PD and APD cohorts were followed from 2010 over their remaining lifetimes. All individuals were ages 65 and over at the start of the simulation. To estimate the value of FS improvement due to LCIG treatment, decreases in activities of daily living (ADL) limitations caused by LCIG treatment were calculated using data from a randomized, controlled, double-blind, double-dummy clinical trial and applied to the APD population in THEMIS. Total burden of disability associated with APD was $17.7 billion (B). From clinical trial data, LCIG treatment versus SoC lowers the odds of difficulties in walking, dressing, and bathing by 76%, 42% and 39%, respectively. Among the APD population, these reductions generated $2.6B in value to patients and cost savings to payers. The added value was 15% of the burden of disability associated with APD and offsets 15% of the cost of LCIG treatment. FS improvements, consistent with improvements due to LCIG treatment, in the APD population created health benefits and reduced healthcare costs in the US.

Disability-inclusive responses to COVID-19: Lessons learnt from research on social protection in low- and middle-income countries.

The one billion people living with disabilities globally already face a heightened risk of poverty, which will likely be exacerbated by the COVID-19 pandemic unless interventions to address its economic impacts are disability-inclusive. This paper draws on the literature on disability, poverty and social protection in low- and middle-income countries to explore the pathways through which the current pandemic may increase the risk of poverty amongst people with disabilities, such as loss of income from disruptions to work, particularly in the informal sector, and higher future spending and productivity losses from disruptions to healthcare and other key services (e.g. rehabilitation, assistive devices). It also explores how social protection and other initiatives to mitigate the economic impacts of the pandemic should consider the needs of people with disabilities, with recommendations for disability-inclusive actions in the design and implementation of eligibility criteria and application procedures, as well as the delivery and content of benefits. Across recommendations, meaningful consultations with people with disabilities, leadership at the program and policy level, appropriate budgeting and monitoring of progress through routine collection of data on disability are key for improving access to and impact of economic responses amongst people with disabilities.

Fiscal episodes in the Economic and Monetary Union: Elasticities and non‐Keynesian effects

AbstractWe estimate short‐ and long‐run elasticities of private consumption for fiscal instruments, using a fixed‐effects model for the 19 Euro area countries during the period of 1960–2017, to assess how fiscal elasticities vary during fiscal episodes. According to the results, positive ‘tax revenue’ elasticities indicate that consumers have Ricardian behaviour, whereby they perceive an increase in taxation to be a sign of future government spending. ‘social benefits’ appear to have a non‐Keynesian effect on private consumption. In addition, using a narrative approach to identify fiscal consolidations, it is seen that private consumption continues to exhibit a non‐Keynesian response to tax increases, both in the short and long‐run, and ‘other expenditures’ have a recessive impact during ‘normal times’. Furthermore, ‘social benefits’ are more contractionary in consolidations than in both expansions and ‘normal times’. In addition, after the launch of the Economic and Monetary Union, expansionary fiscal consolidations became harder to observe, and ‘other expenditure’ and ‘investment’ lost their non‐Keynesian role.

Digital financial literacy, current behavior of saving and spending and its future foresight

ABSTRACT This paper investigates the relationship among digital financial literacy (DFL), current saving behavior, current spending behavior, and foresight of future spending and saving behavior among Indonesian millennials. This research uses structural equation modeling to estimate the relationship among the variables. The research surveyed millennials in the 25–40 age group in several urban areas of Java island. The survey collected information of the indicators constructing the latent variables. The results indicate that DFL is influenced by social-economic standing. DFL also positively affects the current saving and spending behavior. Moreover, the current saving and spending behavior contribute to the future saving and spending foresight. This research suggests policymaker to provide knowledge about DFL to the millennials.

A lost decade? A renewed case for adult social care reform in England

AbstractDrawing on a 2010 analysis of the reform and costs of adult social care commissioned by Downing Street and the UK Department of Health, this paper sets out projected future costs under different reform scenarios, reviews what happened in practice from 2010-19, explores the impact of the growing gap between need and funding, and explores the relationship between future spending and economic growth. In the process, it identifies a ‘lost decade’ in which policy makers failed to act on the warnings which they received in 2010, draws attention to the disproportionate impact of cuts on older people (compared to services for people of working age) and calls for urgent action before the current system becomes unsustainable.

When Prospective Leader Turnover Promotes Peace

AbstractScholars typically associate leader turnover with a high risk of military conflict. This article shows that under some conditions, a higher likelihood of leader turnover in the future fosters peace today. When states take costly peaceful measures (e.g., arming to deter adversaries), the range of settlements preferable to war shrinks and the risk of conflict rises. If peace costs are onerous, potential leader turnover in adversaries promotes peace by introducing uncertainty about the future need for and costs of deterrent measures. When locked in a costly peace with minimal chance of leader turnover in the adversary, states attack. When locked in that same costly peace but with high prospects for leader turnover, states endure an unfavorable peace today given the potential for a favorable one tomorrow. Asymmetric consequences of future shifts in peace costs ensure the relationship holds even if costs do not change in expectation and could rise. Quantitative analyses of the prospects for future leader turnover, military spending, and war initiation among rivals accord with the hypothesized relationships. In theory and practice, expectations of leadership volatility make it prudent to exercise peaceful forbearance.