High Levels Of Spending Research Articles

Measuring fiscal sustainability in the welfare state: fiscal space as fiscal sustainability

This study measures the fiscal capacity of welfare states to derive parameters for a sustainable welfare state. To secure fiscal soundness, it is critical to maintain affordable welfare spending by ensuring public capacity. Adapting the concept of fiscal space, defined as the difference between the current level of public debt and the debt limit implied by the country’s historical record of fiscal adjustment by Ostry et al. (2010) and Ghosh et al. (2011), this research measures and compares the fiscal sustainability of 17 welfare states. To derive this fiscal space, the debt limit of each country is set, primarily based on the estimating of fiscal reaction function and selecting interest schedule (Ghosh et al. 2011, p. F13). We use a pooled-time-series-cross-sectional model to estimate fiscal reaction function and the vector regression model to set the interest schedule. It is found that Southern European welfare states are unsustainable if they do no immediately change their fiscal policies. Countries outside of Southern Europe are generally financially sustainable. However, the UK, the US, and France have in their recent actions exacerbated their financial sustainability. For their part, the social democratic states remain financially sound, despite high levels of welfare spending. This indicates that welfare spending does not necessarily weaken fiscal soundness, which depends on the type of welfare state.

Value from Healthcare and Why It Is Needed in Canada.

Canada's high level of spending on healthcare and lagging performance are leading policy makers and system managers to explore the concept of value. The concept, applied to healthcare, is appearing in medical media and policy documents with increasing frequency and is being used to describe patients' outcomes vis-à-vis the costs of achieving the outcomes. A uniquely Canadian interpretation of value is needed that recognizes that patients', providers' and society's perspectives of the value of the same health service or medical technology differ. This issue of Healthcare Papers presents complementary articles whose authors explore options for improving the value from public spending on healthcare. Commonalities among the articles indicate that improving value from healthcare should focus on understanding what matters to patients and their caregivers and measuring health and health outcomes and that changes in financial incentives are overdue to support a higher degree of integration between providers and their organizations.

Individual and Contextual Influences on Public Support for Military Spending in NATO

ABSTRACT What factors at the individual and country levels influence public support for increased levels of military spending and related foreign policy preferences in NATO countries? Specifically, what individual-level characteristics (e.g., view of NATO) are associated with support for increasing military spending within the NATO alliance, and what country characteristics are associated with shifts in public opinion due to changes in the contextual environment within each country (e.g., military spending/economic growth)? Answers to these questions fill an important gap in the literature by investigating the domestic constraints that influence a country’s response to questions of ‘burden-sharing’ and free riding within NATO. This study examines how citizens’ preferences respond to their domestic political environment, and whether this behavior aligns with the ‘guns versus butter’ trade-off. Findings from a multilevel model combining country-level data with survey data from 13 NATO member countries between 2004–2012 suggest that individuals who view NATO as essential are consistently more likely to support increases in military spending, but changes in the contextual environment, such as high levels of military spending or high levels of economic growth, alter the preferences of individuals in a manner that follows what is known about the trade-offs citizens make between ‘guns versus butter.’

RubenAnderssonNo Go World: How Fear Is Redrawing Our Maps and Infecting Our PoliticsOakland, CA: University of California Press, 2019. xv + 337p. $29.95.

RubenAnderssonNo Go World: How Fear Is Redrawing Our Maps and Infecting Our PoliticsOakland, CA: University of California Press, 2019. xv + 337p. $29.95.

Private education and inequality in the knowledge economy

ABSTRACT This article explores the consequences of public and private spending on education at all levels, looking at skills and income inequality. We use data for 22 affluent democracies from 1960 or 1995 (depending on data availability) to 2017. High levels of public education spending consistently lower income inequality, both measured as wage dispersion and as the education premium. In contrast, higher levels of private education spending are associated with both higher wage dispersion and a higher education premium. We show that this effect works in part through differential skills acquisition. Public education spending raises the math scores of 15-years old students at the mean and at the 25th percentile, but private education spending has no effect on skills at these levels. We find the same pattern among skills of adults; public education spending raises skills at the 25th percentile and the mean; private spending has no effect. Finally, we also show that higher levels of adult skills indeed depress the education premium.

Факторы макроэкономической динамики при переходе к информационной экономике

The study was made of the relationship between GDP growth rates and individual components of its final use by combining factor analysis using the principal component method and regression analysis. The period from 1955 to 1980 was studied using data on the average annual growth rate of components over fiveyear periods in the countries of the non-socialist world. The growth rates of the various components of the use of GDP at different stages as the fourth technical and economic structure of the fourth dominates and the development of crisis phenomena in the economy has had a variable impact on economic growth. During the crisis period, the impact of the growth of all components of using GDP on economic growth has dropped sharply. The greatest role in this period was played by the growth of current expenditures of the state. Comparison of the structure of the use of GDP using factor analysis by the method of principal components was carried out by the average annual values for the period from 1950 to 1980. As the development crisis approaches, as the models show, the influence of factors of the structure of using GDP on economic growth decreases. During the entire period, high levels of government spending had a negative effect on economic growth. The impact of exports and imports was positive for the entire period studied. Overcoming the crisis in the economies of developed countries led to a transition to a positive impact of investment on economic growth.

Saving software from oblivion

In early 2010, Harvard economists Carmen Reinhart and Kenneth Rogoff published an analysis of economic data from many countries and concluded that when debt levels exceed 90 percent of gross national product, a nation's economic growth is threatened. With debt that high, expect growth to become negative, they argued. □ This analysis was done shortly after the 2008 recession, so it had enormous relevance to policymakers, many of whom were promoting high levels of debt spending in the interest of stimulating their nations' economies. At the same time, conservative politicians, such as Olli Rehn, then an EU commissioner, and U.S. congressman Paul Ryan, used Reinhart and Rogoff's findings to argue for fiscal austerity. □ Three years later, Thomas Herndon, a graduate student at the University of Massachusetts, discovered an error in the Excel spreadsheet that Reinhart and Rogoff had used to make their calculations. The significance of the blunder was enormous: When the analysis was done properly, Herndon showed, debt levels in excess of 90 percent were associated with average growth of positive 2.2 percent, not the negative 0.1 percent that Reinhart and Rogoff had found. □ Herndon could easily test the Harvard economists' conclusions because the software that they had used to calculate their results—Microsoft Excel—was readily available. But what about much older findings for which the software originally used is hard to come by? □ You might think that the solution—preserving the relevant software for future researchers to use—should be no big deal. After all, software is nothing more than a bunch of files, and those files are easy enough to store on a hard drive or on tape in digital format. For some software at least, the all-important source code could even be duplicated on paper, avoiding the possibility that whatever digital medium it's written to could become obsolete. □ Saving old programs in this way is done routinely, even for decades-old software. You can find online, for example, a full program listing for the Apollo Guidance Computer—code that took astronauts to the moon during the 1960s. It was transcribed from a paper copy and uploaded to GitHub in 2016.

Institutional Arrangements for Public Library Funding and Spending

Wide variation in institutional structure and funding patterns in public libraries make this government function useful for exploring the effect of these differences on expenditures. Based on literature related to willingness to pay, special districts, and fiscal illusion, we hypothesize that libraries with taxing authority and more revenues from nonlocal sources will have higher levels of spending. We use data from an Annual Public Library Survey, and U.S. Census data, in ordinary least squares (OLS) regressions for 2007 and 2010. We find that taxing authority leads to increased spending, as expected. However, the results of funding sources are contrary to expectations; relative reliance on nonlocal sources is generally associated with lower levels of spending. This may be due to “crowding-out” of local sources, and there may also be some effect from reduced state aid following the Great Recession.

The Differential Effects of Insurance Mandates on Health Care Spending for Children's Autism Spectrum Disorder.

There is substantial variation in treatment intensity among children with autism spectrum disorder (ASD). This study asks whether policies that target health care utilization for ASD affect children differentially based on this variation. Specifically, we examine the impact of state-level insurance mandates that require commercial insurers to cover certain treatments for ASD for any fully-insured plan. Using insurance claims between 2008 and 2012 from three national insurers, we used a difference-in-differences approach to compare children with ASD who were subject to mandates to children with ASD who were not. To allow for differential effects, we estimated quantile regressions that evaluate the impact of mandates across the spending distributions of three outcomes: (1) monthly spending on ASD-specific outpatient services; (2) monthly spending on ASD-specific inpatient services; and (3) quarterly spending on psychotropic medications. The change in spending on ASD-specific outpatient services attributable to mandates varied based on the child's level of spending. For those children with ASD who were subject to the mandate, monthly spending for a child in the 95th percentile of the ASD-specific outpatient spending distribution increased by $1460 (P<0.001). In contrast, the effect was only $2 per month for a child in the fifth percentile (P<0.001). Mandates did not significantly affect spending on ASD-specific inpatient services or psychotropic medications. State-level insurance mandates have larger effects for those children with higher levels of spending. To the extent that spending approximates treatment intensity and the underlying severity of ASD, these results suggest that mandates target children with greater service needs.

POLITICAL REGIME AND PUBLIC SOCIAL SPENDING IN SPAIN: A TIME SERIES ANALYSIS (1850-2000)

AbstractOver the past century and a half, Spain has had a tumultuous political history. What impact has this had on social policy? Democracy has had a positive effect on both the levels of social spending and its long-term growth trend. With the arrival of democracy in 1931, the transition began from a traditional regime (with low levels of social spending) to a modern regime (with high levels of social spending). Franco’s dictatorship, however, reversed this change in direction, retarding the positive growth in social spending. At the same time, the effect of left-wing parties was statistically significant only in the 1930s (prior to the Keynesian consensus) and in the period of the Bourbon Restoration (when the preferences of low-income groups were systematically ignored).

Russian defense spending after 2010: the interplay of personal, domestic, and foreign policy interests

Since 2010, Russia’s defense spending has seen an average annual real growth of 10%, causing a profound shift in the composition of government expenditure. This article examines the formal and informal processes through which Russia’s level of defense spending is determined and identifies personal, domestic, and foreign policy interests behind the rise in defense expenditures. Drawing on a combination of elite interviews and document and news analyses, I argue that domestic political and socioeconomic factors are at least as important as geopolitical and security ones in explaining Russia’s decision to push defense to the forefront of the political agenda. The findings suggest that high levels of defense spending may be politically sustainable in Russia, at least in the medium term, even though it comes at the cost of other public goods.

The Fiscal Sustainability of Alberta's Public Health Care System

From 1975 to 2007, Alberta’s real per capita government health expenditures grew from $1,679 to $3,696 (in 2007 dollars), at a median annual growth rate of 3.5%. Over the same period, Alberta’s real per capita gross domestic product and real per capita total government revenues grew at median annual rates of 2.2% and 1.7%, respectively. This difference between the growth rates of health care spending on the one hand and government revenues and the economy on the other gives rise to concern about the fiscal sustainability of the province’s public health care system. This study presents projections of real per capita spending on public health care in Alberta over the medium term out to 2030. They suggest that, by then, real per capita spending could reach anywhere between $5,339 and $14,215, soaking up between 32% and 87% of total government revenues; more worrying, the high end of these ranges reflects a continuation of the policy settings that guide current provincial public health spending. Alberta is fortunate to have a wealthy economy that can support a high level of public health spending. But that support is precarious given the cyclical nature of non-renewable natural resource revenues and Alberta’s past tendency to experience periods of boom and bust. Basing the financing of key spending programs such as health care on a volatile revenue base is not advisable, for it puts them at risk should economic conditions turn unfavourable, as they have recently. Indeed, adjusting government revenues in our projections to match a more reasonable measure of what might be relied upon with a degree of certainty simply enhances the precariousness of the fiscal sustainability of the public health care system. Not all categories of provincial government health care spending — in particular, the traditional core medicare areas of physician services and hospitals — are growing faster than either the revenue base or the economy. The growth of spending on non-medicare categories such as drugs, capital, and all other health expenditures, however, is a particular source of concern. Options for sustaining provincial government health expenditures include choosing what other government programs could be allowed to grow more slowly over time, what tax rates could be increased to cause the revenue base to grow more quickly, and what health programs currently provided by the public sector instead could be provided privately. These approaches need not exist in watertight compartments, however, and a portfolio of policies that combines these solutions likely would be a pragmatic policy outcome. Such a strategy would help to ensure the fiscal sustainability of Alberta’s public health care system and responsibly provide for the future welfare of its citizens.

There's Nothing Natural About the State of Government Spending in Arkansas

Arkansas is one of the poorest states in the United States, but it has a relatively high level of state government spending compared to similar states. This study examines the drivers of state spending and of spending increases in Arkansas. We investigate both the largest spending categories in absolute terms and categories that have grown significantly in recent decades. We also investigate formal and informal institutional changes that affect state and local government spending. Arkansas has seen significant growth in spending in recent decades. Between 1991 and 2013, state spending has almost doubled, increasing by almost 97 percent even after adjusting for inflation and population. The growth since 1951 has been ever more dramatic, increasing ninefold in real, per capita terms. We investigate what state- and local-level changes have brought about this growth and what institutional changes may have driven the growth, and we suggest institutional reforms.

Demand – Supply – Taxation in Times of Crisis

Abstract The confrontation of the two doctrines, the Keynesianism and the Supply-side economics highlight that the Laffer perspective is the way to achieve solid economic growth on the long way and aims the core of an “exit from crisis” policy. Therefore, this article aims to analyze the hypothesis that a high level of taxation and public spending deters productive behavior and reduces economic growth during recessions. In other words, an easy taxation and low unproductive public spending are desirable for both, the enterprising investor and the consumer. Using the example of Romanian fiscal policy, on one side, we validated within a Vector Error Correction framework that an increase in government revenues harms consumption, investment and the level of employment, in conjunction with a procyclical behavior of fiscal authorities. On the other side, our results showed some positive effects of an increased government expenditures on consumption and employment, which can be explained by the accelerate deterioration of primary balance deficit and the Central Bank’s low interest rate. Moreover, even though the initial positive response of investment to a government spending shock is positive, this is ephemeral and nonsignificant. Our findings highlight that, in order to reach growth on the long-run in times of crisis, the Romanian economy should adopt the fiscal policy and measures suggested by the Supply-side Economics.

Uncovering waste in US healthcare: Evidence from ambulance referral patterns

There is widespread agreement that the US healthcare system wastes as much as 5% of GDP, yet much less agreement on the source of the waste. This paper uses the effectively random assignment of patients to ambulance companies to generate comparisons across similar patients treated at different hospitals. We find that assignment to hospitals whose patients receive large amounts of care over the three months following a health emergency have only modestly better survival outcomes compared to hospitals whose patients receive less. Outcomes are related to different forms of spending. Patients assigned to hospitals with high levels of inpatient spending are more likely to survive to one year, while high levels of outpatient spending result in lower survival. In particular, we discovered that downstream spending at skilled nursing facilities (SNF) is a strong predictor of mortality. Our results highlight SNF admissions as a quality measure to complement the commonly used measure of hospital readmissions and suggest that in the search for waste in the US healthcare, post-acute SNF care is a prime candidate.

Addressing the double-burden of diabetes and tuberculosis: lessons from Kyrgyzstan

BackgroundThe incidence of diabetes and tuberculosis co-morbidity is rising, yet little work has been done to understand potential implications for health systems, healthcare providers and individuals. Kyrgyzstan is a priority country for tuberculosis control and has a 5% prevalence of diabetes in adults, with many health system challenges for both conditions.MethodsPatient exit interviews collected data on demographic and socio-economic characteristics, health spending and care seeking for people with diabetes, tuberculosis and both diabetes and tuberculosis. Qualitative data were collected through semi-structured interviews with healthcare workers involved in diabetes and tuberculosis care, to understand delivery of care and how providers view effectiveness of care.ResultsThe experience of co-affected individuals within the health system is different than those just with tuberculosis or diabetes. Co-affected patients do not receive more care and also have different care for their tuberculosis than people with only tuberculosis. Very high levels of catastrophic spending are found among all groups despite these two conditions being included in the Kyrgyz state benefit package especially for medicines.ConclusionsThis study highlights that different patterns of service provision by disease group are found. Although Kyrgyzstan has often been cited as an example in terms of health reforms and developing Primary Health Care, this study highlights the challenge of managing conditions that are viewed as “too complicated” for non-specialists and the impact this has on costs and management of individuals.

Microfinance Institutions and Empowerment of Women in Rural Area: A Case in Tangerang

The purpose of this study is to discover the performance of the financial independence, the members’ welfare, and accessibility of microfinance institutions to the rural areas in the Tangerang District. To measure the financial dependence is using financial ratios. Measuring levels of performance of the members’ welfare and accessibility using Chi-Square. The results found that, first, the level of welfare of members. The coastal areas have a higher loan value than other regions. Expenditure and income of members, industrial areas have high levels of spending and revenues higher than other regions. The performance of a range to members based on a group basis. Second, the performance of financial independence, categorized as "Healthy". The coastal area is 86.40, the area around the industrial area is 85.71 and agricultural area is 83,73. Third, the level of non-performing loans, the coastal area is 0.03, the industrial area is 0,26, and the agricultural area is 0.19.DOI: 10.15408/sjie.v6i1.4637

Abstract A73: Knowledge of precision medicine among African-Americans: A pilot study

Abstract Precision Medicine has the potential to improve clinical outcomes and minimize risk and adverse effects of treatments and medication. During President Obama's State of the Union address in 2015, he highlighted the promise of precision medicine and announced the Precision Medicine Initiative (PMI). Part of the PMI is the creation of the Precision Medicine Initiative Cohort. This program aims to recruit at least one million Americans to contribute their data over the span of many years to improve health outcomes, understand the impact of new treatments, and accelerate a new era of data-drive and precise preventive care and treatment. Precision medicine could address multiple issues we face, including cancer treatment and address health disparities in health disparity populations. However, little is known about health disparities populations' knowledge level of precision medicine. A pilot study was conducted to investigate whether self-identified Blacks/African-Americans could define the following terms in their own words: precision medicine, personalized medicine, and pharmacogenomics. Self-administered surveys were handed out at health fairs, barbershops, salons, and churches throughout the state of Florida and 132 (n=132) individuals responded. Participants were asked to provide demographic data, note whether or not they have heard a particular PMI concept, define the concept in their own word (if familiar with the term), and whether or not precision medicine can improve cancer care and treatment. Sixty-two percent of individuals had a college degree and 71% of respondents were employed. 81% of individuals (n=107) have never heard of pharmacogenomics, 55% (n=73) have never heard of personalized medicine, and 77% (n=102) have never heard of precision medicine. 9% (n=12) believe that precision medicine will improve cancer care and treatment, but n=72 marked “I don't know.” Critical to PMI is the enrollment of citizens into the research cohort. Increasing the diversity of the national research cohort is imperative as there are high levels of health disparities and unnecessary medical spending in our health care setting. Yet, if individuals are not aware of precision medicine and corresponding precision medicine concepts, they are unlikely to volunteer and participate in the PMI. The lack of diversity within clinical trials has caused issues and concerns within the medical community. By ensuring that the PMI cohort is inclusive, diverse, and representative of the American population, its ability to address health disparities will be more effective, efficient, and ethical. Citation Format: Jennifer Nguyen, Christina Redwine, Lauren Gilbert, Folakemi Odedina. Knowledge of precision medicine among African-Americans: A pilot study. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A73.

Comparative analysis of the effectiveness of the public sector of the Republic of Serbia and transitional countries

The transition process that affected the countries of Central and Eastern Europe have led to recession and rising unemployment. The global financial crisis has actualized the problem of over-indebtedness of transition and post-transition countries. These processes did not bypass the countries in the region, nor the Republic of Serbia. High levels of public spending and unreformed public sector of the Republic of Serbia led to constant budget deficits, public crises and instability of public finance system. By analyzing and comparing the efficiency of the public sector in transition countries and the Republic of Serbia, levels of efficiency, sources of inefficiency and the need for state intervention has been determined. Applied method of analysis is of relative character and measures wider socio-economic impact of the public sector, as well as the impact of the level of growth of public spending on the performance and efficiency of the public sector. The results need to be interpreted with caution, since the public sector and public finance systems differ from country to country. Disadvantages of national statistics condition the approximation of certain categories of public expenditure.

Child Health Systems in the United Kingdom (England)

Child health in the United Kingdom has improved markedly over recent decades but has failed to match health gains and reductions in mortality achieved by other European countries. Child poverty and inequalities are rising in the United Kingdom. The National Health Service (NHS) is a universally accessible health service, funded by taxation and is free at the point of use. The NHS is undergoing substantial reform, aiming to improve care quality and experience, meet rising demands, and contain costs. The NHS is struggling to balance access with expertise for urgent and unscheduled care. There is increasing use of urgent and emergency care, and there are unexplained variations in outcomes. Quality of care for children and young people with chronic and long-term conditions, including transition services, is variable and sometimes poor. Many determinants of noncommunicable conditions are worsening. Key achievements include a universal service free at the point of use, providing generally accessible, and equitable care. Key challenges include increasing fragmentation of services, insufficient emphasis on preventive care, achieving an effective balance between access and expertise of care for children, and improving child health and well-being outcomes despite generally high quality inputs and high levels of spending.