Percent Increase In Spending Research Articles

A Unified Cost-Sharing Design for Medicare: Effects on Beneficiary and Program Spending

In this report, we examine a potential reform to Medicare that would simplify coverage for fee-for-service beneficiaries, streamline cost-sharing obligations under a uniform deductible for Medicare Parts A, B, and D services, and create an out-of-pocket maximum to protect beneficiaries from high financial burdens. We assess the potential impacts of the unified cost-sharing policy on beneficiary and program spending using MCARE-SIM, a new microsimulation model designed to estimate the effects Medicare policy reforms. Under the policy, beneficiary out-of-pocket spending would decline or remain similar for 35.1 of the 39.4 million fee-for-service Medicare beneficiaries and 4.3 million beneficiaries would experience at least a 5 percent increase in spending. Medicare spending would increase by $31.2 billion (a 5.7 percent increase) relative to current law in 2020.

Federal Funding Insulated State Budgets From Increased Spending Related To Medicaid Expansion.

As states weigh whether to expand Medicaid under the Affordable Care Act (ACA) and Medicaid reform remains a priority for some federal lawmakers, fiscal considerations loom large. As part of the ACA's expansion of eligibility for Medicaid, the federal government paid for 100percent of the costs for newly eligible Medicaid enrollees for the period 2014-16. In 2017 states will pay some of the costs for new enrollees, with each participating state's share rising to 10percent by 2020. States continue to pay their traditional Medicaid share (roughly 25-50percent, depending on the state) for previously eligible enrollees. We used data for fiscal years 2010-15 from the National Association of State Budget Officers and a difference-in-differences framework to assess the effects of the expansion's first two fiscal years. We found that the expansion led to an 11.7percent increase in overall spending on Medicaid, which was accompanied by a 12.2percent increase in spending from federal funds. There were no significant increases in spending from state funds as a result of the expansion, nor any significant reductions in spending on education or other programs. States' advance budget projections were also reasonably accurate in the aggregate, with no significant differences between the projected levels of federal, state, and Medicaid spending and the actual expenses as measured at the end of the fiscal year.

Does Higher Spending Improve Survival Outcomes for Myocardial Infarction? Examining the Cost-Outcomes Relationship Using Time-Varying Covariates.

Previous patient-level acute myocardial infarction (AMI) research has found higher hospital spending to be associated with improved survival; however, survivor-treatment selection bias traditionally has been overlooked. The purpose of this study was to examine the AMI cost-outcome relationship, taking into account this form of bias. Hospital Discharge Abstract data tracked costs for AMI hospitalizations. Ontario Vital Statistics data tracked patient mortality. A standard Cox survival model was compared to an extended Cox model using hospital costs as a time-varying covariate to examine the impact of cost on 1-year survival in a cohort of 30,939 first-time AMI patients in Ontario, Canada, from 2007 to 2010. Higher patient-level AMI spending decreased the hazard of dying (Standard Model: log-cost hazard ratio: 0.513, 95 percent CI: 0.479-0.549; Extended Model: log-cost hazard ratio: 0.700, 95 percent CI: 0.645-0.758); however, the protective effect was overestimated by 62 percent when survivor-treatment bias was overlooked. In the extended model, a 10 percent increase in spending was associated with a 3.6 percent decrease in hazard of death. The findings of this study suggest that if survivor-treatment bias is overlooked, future research may materially overstate the protective effect of patient-level spending on outcomes.

The Effect of Initiatives on Local Government Spending

Tools of direct democracy, such as the citizen initiative, are available at both the state and local levels in the United States, yet models of the process typically do not consider these institutions in tandem. In this article, I develop a model of local fiscal policy that incorporates the impact of a statewide as well as a local initiative process. I posit that the statewide initiative process leads to lower levels of state spending, additional spending mandates on the local level, and reduced deadweight costs of taxation, with these three factors leading to an increase in local spending. I then show that the ability of interest groups to secure particularistic spending through the local initiative has a similarly pro-spending impact. Subsequently, I explore data from the year 2000 in over 600 cities with a population greater than 25,000 and find that the spending-enhancing effects of the local initiative are strong when signature requirements are low, leading to a 12—14 percent increase in spending compared to local governments without such an initiative process in place.

Industrial Research Institute's 7th Annual R&D Leaderboard

spending by the top 100 U.S. and non-U.S. investors in 2004. In 2003, U.S. industry saw a robust turnaround in spending, with a 5.4 percent increase by the top 100 investors over the previous year. This trend continues. Spending in 2004 by the top 100 U.S. companies increased from 2003 by 7.4 percent to $127 billion. Sales for these same companies increased by 12.4 percent and profits were up another 31.5 percent for the second year in a row! gains in expense represent a real increase, as the growth significantly outpaced inflation again in 2004 as it did in 2003. total spending by the top 100 companies shown in Table 1 represents more than two-thirds of all U.S. industry spending, which was about $187 billion in 2004. Microsoft, at the top of the list, spent $7,779 million on in 2004, moving it ahead of Ford which held that position for several years. In 2003, Microsoft was the sixth-largest spender behind Ford, Pfizer, General Motors, IBM, and Johnson and Johnson. However Microsoft's dramatic increase in rank is partly the result of a change in its accounting practices (see The FASB Directive, below). rank order of several other companies was also affected by this same change in accounting practice. Three of these-Google, Yahoo, and Symantec-are new additions to the Top 100. relative spending by the 91 companies that appear among the top 100 spenders for both 2003 and 2004 was only 6.4 percent. However, the nine new additions to the top 100 increased their spending by an average of 62.9 percent. One firm among this group, Biogen-Idec, reported a nearly 195 percent increase in spending, largely the result of Idec's acquisition of Biogen in late 2003. Seven of the nine new additions this year were from either the health care or Internet services industries, including the three noted above. increase in spending by U.S. industry in 2004 was broad-based, with 76 of the top 100 companies boosting their spending, compared with only 68 in 2003. Of the 24 companies decreasing spending, 11 were continuing their downward spiral from 2003 and earlier. Most of these were in the communications equipment, computer equipment and electronics industries. Among the top 100, the communications equipment industry was the only market segment to exhibit an overall decrease in spending. largest increases were in the biotech and software industries. Intensity Decreases Despite the overall increase in spending, R&D as measured by R&D expense as a percent of sales, for the top 100, decreased from 5.8 percent in 2003 to 5.6 percent in 2004. This was because sales increased by 12.4 percent, an even greater rate of increase than that of spending. intensity is higher for the top 10 companies (7.2 percent) than for the top 25 companies (7.0 percent) and the latter higher than the top 50 companies (5.7 percent) and that higher than the top 100. This trend continues with the intensity of the top 1,000 companies at 4.3 percent-a reasonable estimate of the intensity for all U.S. industry in 2004. More significant is the great variation in intensity by market segment, with the leaders by this standard being those in the health care, electronics and computer software industries. This same trend and variation is also found in the spending per employee, with the largest spenders as a group investing the greatest amount per company employee. top 10 companies spend nearly 50 percent more per employee than the average for the top 100. Companies in the biotech, pharmaceutical, electronics, computer hardware and software industries spend much more on per employee than companies in most other industries. Non-U.S. Leaderboard For the first time, we are presenting an Leaderboard composed of only non-U. …