High Levels Of Spending Research Articles

PRIVATE AND PUBLIC PENSION SYSTEMS WORLWIDE: CASE OF RUSSIA

The article deals with the Russian pension system and make recommendations for its further development on the basis of international experience. The Russian pension system is in a state of transition. The reform of 2013-2015 is not completed, since in its current state pension system is still characterized by very low replacement rate value at a very high level of government spending. Moratorium on pension accumulation introduced in the course of recent reforms calls into question the future of the mandatory funded pension system. Review of international pension systems formation suggests that the most successful of them are not limited solely to public system, and use a combination of distribution and accumulation units. When choosing between mandatory or voluntary options they are guided by the characteristics of the national economy. Studying the successes and mistakes of world practice of voluntary and mandatory funded pension systems is of great scientific and practical interest, since it can contribute to a more accurate choice of the future path of development of the national pension system.

Cost-Effectiveness and Clinical Practice Guidelines: Have We Reached a Tipping Point?—An Overview

Given recent developments in the United States, where professional clinical societies have attempted to define “value” and consider it in their deliberations about appropriate care, this thematic article describes those recent specialty society efforts in the United States in cardiology and oncology and the multispecialty efforts in the United Kingdom for over 10 years. Despite our high levels of health spending, and our field’s long and consistent approach to the basic tools of cost-effectiveness analysis (CEA), US private and public payers are not routinely or explicitly using CEAs in their reimbursement decisions. This is a puzzle that raises the following question: Why does the United States have so many skilled pharmacoeconomic practitioners and produce so many CEAs given this apparent lack of interest and trust? There are multiple reasons, but the lack of incentives to use the information certainly matters. This article identifies and discusses a number of key issues and challenges for incorporating CEA into US clinical guidelines development: potential bias in manufacturer-sponsored CEAs, the role of societal perspective, payer-subscriber and physician-patient agency relationships, the need for disease area CEA studies and modeling, patient heterogeneity, investigators’ conflicts of interest, assessing the quality of economic studies, and aggregation of information using multicriteria decision analysis. These developments suggest that the application of CEA in health care decision making in the United States is evolving and may be approaching a tipping point. With increasing pressures on drug prices, perhaps reflecting challenges to industry sustainability, payers, providers, and patients are looking for value for money. CEA should be an important part of this process.

The ACA's Dependent Coverage Expansion and Out-of-Pocket Spending by Young Adults With Behavioral Health Conditions.

Young adults with behavioral health conditions (mental or substance use disorders) often lack access to care. In 2010, the Affordable Care Act (ACA) extended eligibility for dependent coverage under private health insurance, allowing young adults to continue on family plans until age 26. The objective of this study was to analyze out-of-pocket (OOP) spending as a share of total health care expenditures for young adults with behavioral health conditions before and after the implementation of the ACA dependent care provision. The study examined the population of young adults with behavioral health conditions overall and by race and ethnicity. The study analyzed 2008-2009 and 2011-2012 nationally representative data from the Medical Expenditure Panel Survey with zero-or-one inflated beta regression models in a difference-in-differences framework to estimate the impact of the ACA's dependent coverage expansion. OOP spending was examined as a share of total health care expenditures among young adults with behavioral health disorders. The study compared the treatment group of individuals ages 19-25 (unweighted N=1,158) with a group ages 27-29 (unweighted N=668). Young adults ages 19-25 with behavioral health disorders were significantly less likely than the older group to have high levels of OOP spending after the implementation of the ACA's dependent coverage expansion. The reduction was pronounced among young adults from racial-ethnic minority groups. The extension of health insurance coverage to young adults with behavioral health disorders has provided them with additional financial protection, which can be important given the low incomes and high debt burden that characterize the age group.

Access to new cancer medicines in Australia: dispelling the myths and informing a public debate.

Despite the high level of spending on cancer medicines in Australia, consumer organisations and the pharmaceutical industry often make claims of delayed or lack of access to new cancer medicines—claims that are frequently supported by prominent coverage in the Australian media. These claims, while morally and psychologically compelling, tend to ignore the complexity of medicines funding decisions. In this commentary we summarise the current situation regarding the registration and funding of cancer medicines in Australia, elucidate the main challenges associated with access to cancer medicines in the Australian context, and describe some of the steps that have been taken to address these challenges.

High Out-of-Pocket Medical Spending among the Poor and Elderly in Nine Developed Countries.

The design of health insurance, and the role out-of-pocket (OOP) payments play in it, is a key policy issue as rising health costs have encouraged greater cost-sharing measures. This paper compares the percentage of Americans spending large amounts OOP to meet their health needs with percentages in eight other developed countries. By disaggregating by age and income, the paper focuses on the poor and elderly populations within each. The study uses nationally representative household survey data made available through the Luxembourg Income Study. It includes nations with high, medium, and low levels of OOP spending. Households have high medical spending when their OOP expenditures exceed a threshold share of income. I calculate the share of each nation's population, as well as subpopulations within it, with high OOP expenditures. The United States is not alone in exposing large numbers of citizens to high OOP expenses. In six of the other eight countries, one-quarter or more of low-income citizens devoted at least 5 percent of their income to OOP expenses, and in all but two countries, more than 1 in 10 elderly citizens had high medical expenses. For some populations in the sample nations, health insurance does not provide adequate financial protection and likely contributes to inequities in health care delivery and outcomes.

Compulsive buying and depressive symptoms among female citizens of the United Arab Emirates

Compulsive buying is particularly relevant in nations with high levels of consumer spending. Most previous studies have focused on European and North America populations. This study explores compulsive buying amongst citizens of the United Arab Emirates, an Arab nation with high retail outlet density, and high levels of consumer spending. Female college students (N=100) completed an English/Arabic version of the compulsive buying scale along with a measure of depression. Rates of compulsive buying were higher than those reported in any previously published study. Furthermore, in line with previous findings from other nations, compulsive buying was associated with elevated depressive symptomatology.

Political Regime and Social Spending in Spain: A Time Series Analysis (1850-2000)

Over 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 nineteen-thirties (prior to the Keynesian consensus) and in the period of the Bourbon Restoration (when the preferences of low-income groups were systematically ignored).

Accountability of Hospitals for Medicare Beneficiaries' Postacute Care Discharge Disposition.

Accountability of Hospitals for Medicare Beneficiaries' Postacute Care Discharge Disposition.

The U.S. Presidential Campaign, 2016

This essay explores the 2016 election using 1964 for comparison. The central theme is that 1964 set the context for subsequent presidential elections. Issues and public policy revolved around the standards set by the 1964 converting election. Both race and religion played a role in the 1964 converting election that redefined the Democratic Party as the liberal political party for the nation, and the Republican as its conservative counterpart. This established a political regime that endures until the present day, but its endurance has had deleterious consequences for the discussion of new proposals. Change happens slowly and piecemeal. Both parties maintain high levels of spending as politics has been reduced to administration, a technocracy rather than representative democracy. The resulting pressures and frustrations manifest themselves with increasing frequency in the political system. The tumultuous 2016 campaign is the latest manifestation of this dissatisfaction among voters. Given the peculiarities of 2016, are we on the verge of a historic realignment, one that may set a similar standard for a generation?

Family Background, Private Tutoring, and Children’s Educational Performance in Contemporary China

The prevalence of private tutoring is often noted in the literature on education in East Asia. Empirical evidence concerning the causes and consequences of private tutoring, however, is sparse, especially for China. In this article, we draw upon data from the 2010 China Family Panel Studies to explore whether children’s tutoring experiences are influenced by family background and whether private tutoring benefits children’s educational performance. Our empirical analyses show that higher parental education, higher family income, and fewer siblings are all associated with a higher likelihood of private tutoring and higher levels of spending on it. Furthermore, private tutoring and spending on tutoring are predictive of higher verbal and math performances, although the difference in math performance between children who received private tutoring and those who did not is statistically insignificant after controlling for family background.

What future for taxation in the EU?

The 11th EUROFRAME Conference on economic policy issues in the European Union was held in Paris on 6 June 2014. The aim of the conference is to provide an economic forum for debate on economic policy issues relevant in the European context. In June 2014 the Conference topic was: “What future for taxation in the EU?”. The programme and conference papers are available at the EUROFRAME Conference webpage: www.euroframe.org. Six of the papers given at the Conference are released in this issue of the Revue de l’OFCE. European economies have high taxation levels, which allow financing the European Social Model,characterised by a high level of public and social spending. In 2012, the tax-to-GDP ratio was 39.4% for the whole EU, 40.4% for the euro area, as compared to 39.4% for Japan and 24.5% for the US. There are however wide disparities within the area. The tax-to-GDP ratio is higher than 45% in Denmark, Belgium and France, and ranges between 45% and 40% in Sweden, Finland, Italy and Austria. But it is below 35% in Greece, Spain, Poland, and Portugal; 30% in Slovakia, Ireland, Romania, and Bulgaria. There was no trend in the tax-to-GDP ratio developments at the EU level over the last 20 years.

The great tax reform, a French myth

The need for a great tax reform is often debated in France, although the content and objectives of such a reform are never clearly specified. There is no unanimity on how the tax reform should be designed, some advocating that the reform should aim at cutting taxation (which implies further public spending cuts) while according to some others the tax system become more progressive. The French tax-to-GDP ratio is 46%, and primary public expenditure amount to 50% of potential GDP. This high level of public spending reflects a choice of society, which should be maintained. The French tax system is already very progressive, similar taxation applies to capital and labour incomes. France is one the very few countries where inequalities have not risen in the recent past. The paper addresses, for each category of tax, the reforms which could be introduced, and discusses whether they would be appropriate. In particular, the paper shows that replacing employers’ social contributions by VAT would be useless. It is desirable but difficult to raise environmental taxation; French taxation should remain family-based, merging the income tax with the CSG is not desirable. Tax expenditures should be reconsidered, especially as concerns companies’ and households’ tax optimization schemes. Merging PPE and RSA is not obvious. A competitiveness shock (i.e. strong cuts in employers’ social contributions and corporate taxation financed by a rise in CSG) should be implemented only in a European context.

Materialism, Spending, and Affect: An Event-Sampling Study of Marketplace Behavior and Its Affective Costs

Research on materialism has burgeoned in the last two decades, yet little is known about how people higher versus lower in this consumer values orientation differ in their day-to-day spending habits and in their emotional reactions to spending on purchases. The present study used an event-sampling method over a 3-week period to address these questions in a community adult sample. Results showed that over the course of the sampling period, high materialists made more discretionary purchases and spent more money on necessity purchases than did those lower in materialism, even though their incomes did not differ. Despite higher levels of spending, high materialists experienced a “letdown” after spending, as they reported more post-purchase unpleasant affect than did low materialists. This result was not moderated by level of dispositional unpleasant affect, purchase type, or purchase amounts.

Global Economic Shock Spillovers to the Saudi Economy: An Assessment Framework

This paper introduces a framework for assessing global shock spillover specifically address the global financial spillovers to the Saudi economy by exploring the main fundamental determinants of creditworthiness including key global factors, Macroeconomic and Financial Sector vulnerability. Finally highlights the extent to which the Saudi financial system have been able to regain a sound standing in the aftermath of the recent financial crises to which they have been subjected. The main conclusion is that global financial crisis has had limited direct impact so far on domestic financial markets but, the country was and still effected through trade, reflected in high inflation rate, tighter liquidity and weak investor confidence. Government generous spending has been successful in reducing the impact of the global crisis, but Saudi Arabia should adopt alternative venue to the current high spending levels. In light of anticipated fall in oil prices, the current strategy is not sustainable.

Global trends in forest ownership, public income and expenditure on forestry and forestry employment

This paper presents results of analyses of data from the 2015 Global Forest Resources Assessment on changes in forest ownership, public income and expenditure on forestry and forestry employment. Forest ownership continued to show less state control and ownership of forests. This was due to private-sector investment and, in some countries, the transfer of public forests to the private-sector (including local communities). This contrasts somewhat with results on public income and expenditure, which indicate that public expenditure on forestry has increased dramatically over the last decade, while income has increased by very little. Global employment in forestry has not changed much over the last two decades and has remained at about 12.7million people, with the majority of these employed in informal activities, particularly in Asia. While production of many if not most forest goods and services has increased, labour productivity has improved at the same time, leading to this result. Comparing the results for groups of countries at different income levels, it appears that higher income countries tend to have a relatively high proportion of private forest ownership, high levels of labour productivity and high levels of public spending (per hectare) on forestry. However, apart from these very general differences in outcomes related to income levels, there does not appear to be strong correlation between these socioeconomic variables and other forest-related variables collected in the FRA.

Spreadsheets and the Violence of Forms: Tracking Organisational and Domestic Use

Spreadsheets and the Violence of Forms: Tracking Organisational and Domestic Use

Ways to Identify Children with Medical Complexity and the Importance of Why

Children with medical complexity, although a small fraction of the pediatric population, are important due to their high levels of healthcare spending, unmet healthcare needs, substandard quality of care, and poor health outcomes. 1 Consistent with the Triple Aim, 2 these children are the focus of clinical, research, and policy initiatives seeking to: (1) improve their healthcare experience and quality of care; (2) improve outcomes (for themselves and their families); and (3) reduce the future healthcare costs that they might accrue. 3-8 Clinics, hospitals, states, and countries throughout the world are reforming the health system to optimize its performance for children with medical complexity. 9,10 Although the act of recognizing that a particular child is medically complex may seem straightforward at the individual level, identifying children with medical complexity at a population level is not straightforward. At the individual level, recognizing medical complexity is a subjective distinction, 11 drawing on a person’s experiences and perceptions of viewing a child as being medically complex. 12 When scaled up to population-level, 3 challenges emerge. First, the construct of medical complexity is regarded differently among parents, clinicians, researchers, and others. Second, individual-level details about the child that are evident or discoverable in a one-on-one, in-person encounter (eg, an outpatient clinic visit) are often not readily available in population-level data sources. Third, in contrast to their adult counterparts, children with medical complexity have a heterogeneous array of rare health problems without a select few that dominate in prevalence and impact. With these caveats in mind, we review existing techniques and tools that can be used to identify children with medical complexity from a variety of health data sources, including administrative billing data and parent- or providerreported survey. We organize our review with Cohen et al children with medical complexity definitional framework of interacting characteristics, including complex chronic health problems, substantial healthcare needs, severe functional

Single-use negative pressure wound therapy for the treatment of chronic lower leg wounds.

Lower extremity ulcers are caused by multiple disease processes and contribute to a high level of patient morbidity and health-care spending in the US. Negative pressure wound therapy (NPWT) has been used extensively for wound bed preparation. Our aim is to assess the efficacy of an affordable, low-profile single-use NPWT (single-use NPWT) on chronic lower extremity wounds that would usually be deemed too small or superficial for traditional NPWT. A prospective pilot study was undertaken in which chronic lower extremity wounds were treated with single-use NPWT. Study visits were biweekly for primary contact dressing change, with the negative pressure unit being changed weekly. Biweekly assessments were made of wound appearance, surface area, depth, exudate amount, peri-wound skin integrity, and signs of clinical infection. Digital photography was performed at each visit. Patients with venous leg ulcers (VLUs) were treated with a 3-layer wrap. Diabetic foot ulcers (DFUs) were treated with off-loading shoes. The study recruited 12 patients. There were 13 wounds in total; two DFUs, two traumatic/postoperative/pressure ulcers, and nine VLUs. DFUs decreased in size on average 62%, VLUs by 32%, and traumatic/postoperative/pressure wounds by 74%. The wound appearance became more favourable and the wound depth decreased with the use of single-use NPWT. Single-use NPWT is a suitable therapy for chronic lower extremity wounds. Single-use NPWT led to a decrease in wound size and depth, an increased amount of granulation tissue, and a high level of patient satisfaction, with a low complication rate. This study was funded by Smith & Nephew, Hull, UK. JC Lantis is a paid consultant for KCI, Smith & Nephew, Healthpoint and Macrocure. C Gendics is a paid consultant for Macrocure and ManukaMed.

Building an International Bank for Right Livelihood

Building an International Bank for Right Livelihood

Determinants of external debt in South Africa: a VAR-based approach

The external debt issue has recently been a subject of topical concern in South Africa. In the 2014 budget review, the Treasury proposed to increase external debt as a percentage of GDP from the 2013 figure of 39.9% to about 43.9% by 2016. This proposal was contrary to the IMF recommendation that South Africa should cut its external debt to figures below 40% of its GDP. In this paper, the vector auto-regression model was used to analyse the determinants of the South African external debt utilising annual data from 1980-2013. Empirical results reveal that external debt in South Africa is mainly due to sluggish levels of economic growth and high levels of government spending on infrastructure.