Spending Growth Research Articles

Hybrid Clustering and Classification of At-Risk Customer Segments in Network Marketing

Customer segmentation is a fundamental strategy for sustaining retention in network marketing businesses, where repeated transactions and multilayered relationships significantly impact long-term customer value. This study proposes a hybrid machine learning framework to classify at-risk customer segments—comprising regular customers, seasonal buyers, and churn-risk profiles—by integrating unsupervised clustering and supervised classification methods. A total of 36 engineered behavioral features were derived from longitudinal transaction data to capture spending behavior, recency, variability, and growth dynamics. Clustering algorithms including K-Means, Agglomerative Hierarchical Clustering, and Gaussian Mixture Models were applied and evaluated using standard clustering validity indices: Silhouette Score, Davies–Bouldin Index, and Calinski–Harabasz Index. K-Means with six clusters produced the most interpretable and balanced segmentation outcome. Cluster relabeling was conducted to align with business-relevant categories, followed by supervised validation using classifiers such as Decision Tree, Gradient Boosting, K-Nearest Neighbors (KNN), Random Forest and Support Vector Machine (SVM). Among these, SVM yielded the highest predictive accuracy (92.53%) and F1-Score (92.52). The results demonstrate the effectiveness of the proposed hybrid approach in enhancing segmentation precision and facilitating early detection of potential churn in a dynamic marketing environment.

National Health Expenditure Projections, 2024-33: Despite Insurance Coverage Declines, Health To Grow As Share Of GDP.

National health expenditures are projected to have grown 8.2percent in 2024 and to increase 7.1percent in 2025, reflecting continued strong growth in the use of health care services and goods. During the period 2026-27, health spending growth is expected to average 5.6percent, partly because of a decrease in the share of the population with health insurance (related to the expiration of temporarily enhanced Marketplace premium tax credits in the Inflation Reduction Act of 2022) and partly because of an anticipated slowdown in utilization growth from recent highs. Each year for the full 2024-33 projection period, national health care expenditure growth (averaging 5.8percent) is expected to outpace that for the gross domestic product (GDP; averaging 4.3percent) and to result in a health share of GDP that reaches 20.3percent by 2033 (up from 17.6percent in 2023).

Driving Local Productivity: The Interplay of MSMEs, Government Spending, and Economic Growth

The strategic development of Micro, Small, and Medium Enterprises (MSMEs) and government spending are pivotal drivers of local productivity and regional economic growth. However, existing empirical investigations often lack an integrated framework linking these crucial factors. This study addresses that gap by analyzing the influence of MSME growth and government spending on local sector productivity and their subsequent implications for economic growth dynamics in Lampung Province, Indonesia. Adopting a quantitative survey design, this research collected primary data from 190 purposively selected respondents, comprising MSME actors and government officials across key economic sectors. Supporting secondary data was also utilized. The study employed Structural Equation Modeling–Partial Least Squares (SEM-PLS) to test seven hypotheses. The findings unequivocally demonstrate that MSME growth and government spending significantly influence the dynamic of economic growth and local sector productivity. Moreover, local sector productivity also significantly influences economic growth. Last but not least, both MSME growth and government spending have significant indirect influences on economic growth through local sector productivity. This study advances the understanding of the causal mechanisms linking fiscal policy and MSME dynamics within regional development frameworks. It further emphasizes the critical importance of synergy between local governments and MSME stakeholders to ensure inclusive and sustainable economic growth. Future research is encouraged to explore sector-specific policy impacts through longitudinal and mixed-method approaches for more profound insights.

Dynamic Difficulty Algorithms as a Tool for Enhancing Player Retention: An Empirical Study in a Gaming Environment

This article examines the application of dynamic difficulty algorithms to optimize player retention and monetization metrics in free-to-play projects through an empirical study conducted within a gaming environment. The fact that key indicators of a project’s viability in the F2P industry, such as D1/D7/D30 retention, directly correlate with LTV and operating profit, makes the research relevant. Traditional static difficulty curves give rise to the “difficulty paradox” — boredom or frustration that accelerates churn. In contrast, DDA promises to keep the player in Csíkszentmihályi’s “flow” zone by balancing challenge and skill. This study aims to demonstrate, on causal data, the effect of algorithmically adaptive difficulty on user retention and revenue. The novelty of the work lies in a large-scale randomized controlled experiment that combines the segmentation of “at-risk” and “core-spender” cohorts, as well as an A/B-testing and RCT methodology, to evaluate DDA as a scalable product parameter rather than merely a UX enhancement. The main findings show that night-by-night decreasing difficulty for the “at-risk” subgroup increases D30 retention by 3 percentage points, yields, on average, one additional day of play and ten more rounds per user per month, and an LTV uplift of $ 0.08 per user, where IAP and 21% by advertising generate 79% of the increase. The effect is heterogeneous: the “core-spender” segment primarily exhibits a financial response, whereas “frustrated” players increase their play activity without significant growth in spending. A comparative analysis revealed that simple heuristics offer a baseline uplift, while classical ML models can ensure up to a 20% retention growth. Additionally, RL agents and hybrid fuzzy-RL solutions can retain players longer at comparable computational costs. At the same time, generative LLM-based controllers open up prospects for unifying DDA approaches. This article will be helpful to game-product analysts, personalization-system developers, and monetization managers in the video-game industry.

EDUCATION, HEALTH AND ECONOMIC GROWTH NEXUS: NEW EVIDENCE FROM SIERRA LEONE

<p>This study investigates the impact of health and education spending on economic growth in Sierra Leone. The study utilizes the autoregressive distributed lag estimation technique with quarterly time series data spanning from 2000Q1 to 2022Q4. The unit root test result confirms a mixture of I(0) and I(1) variables, while the bound test establishes cointegration. The long-run findings suggest that education spending has a significant negative impact on economic growth, while health expenditure is growth-enhancing. Also, the result indicates that foreign direct investment inflows boost growth, but inflation impedes growth in the long run. The short-run dynamics show that lagged economic growth has a positive impact on the current growth rate. Furthermore, the findings confirm a positive relationship between health spending and economic growth, while the lagged value of health spending and the current level of education expenditure stifle growth. The short-run findings for both FDI and inflation corroborate with the long-run results. The result of the error correction term (ECT) indicates that any disequilibrium to the model is corrected at an adjustment speed of 11.8% towards long run equilibrium. The findings of this study emphasize the need for more government spending to strengthen the health sector and also ensure accountability and transparency in the disbursement and utilization of funds for the education sector.</p><p> </p><p><strong>JEL: </strong>C22, H51, H52, O55<strong></strong></p><p> </p><p><strong> Article visualizations:</strong></p><p><img src="/-counters-/soc/0859/a.php" alt="Hit counter" /></p>

Shifts in Medicare spending for patients with cancer undergoing chemotherapy following implementation of the Maryland Global Budget Revenue program.

11079 Background: In January 2014, the statewide Maryland Global Budget Revenue (GBR) model was implemented to control the growth in total hospital spending and improve the quality of care. Specific impacts of GBR on cancer-related spending are not fully understood. This study aimed to 1) quantify the impact of GBR on Medicare spending for beneficiaries undergoing chemotherapy for cancer and 2) investigate any shift in such spending during GBR to non-hospital settings. Methods: Using 2011-2018 Medicare claims from Maryland and a control set of 11 comparable states, we constructed 6-month chemotherapy episodes. Propensity matching was used to identify appropriate comparison episodes based on treatment year, patient demographic, clinical, and area-level characteristics. Using a difference-in-differences (DiD) approach, we evaluated the impact of GBR on standardized total Medicare payments and non-hospital professional payments during the episode, after confirming the parallel trends assumption during GBR’s pre-period (2011-2013). Results: Among 42,206 and 708,486 chemotherapy episodes in Maryland and control states, respectively, we studied 42,199 episodes in Maryland matched to 42,199 episodes in control states. Our analysis showed that GBR’s implementation led to smaller increases in total episode payments over time relative to control states and larger increases in non-hospital professional payments (Table); these impacts notably varied with time. Conclusions: Our finding of smaller increases in total Medicare payment for a 6-month chemotherapy episode in Maryland versus control states indicates that GBR’s intended reductions on the spending growth in the context of cancer patients undergoing chemotherapy were actualized. Importantly, larger increases in non-hospital professional payments suggest these savings may have been attained via shifts in sites-of-care following GBR’s implementation. Further studies evaluating the effects of these shifts on cancer care quality are warranted. Adjusted mean standardized payments in 2018 dollars during 6-month chemotherapy episodes and DiD estimates versus 2013. Total payments Non-hospital professional payments Year Adjusted Mean, Maryland Adjusted Mean, Control states DiD Adjusted Mean, Maryland Adjusted Mean, Control states DiD 2013 $54,213 $52,659 Ref $22,876 $14,844 Ref 2014 $54,522 $53,476 -$759 $21,261 $14,327 $828 2015 $55,355 $55,426 -$2,001 $22,249 $14,186 $1,433* 2016 $58,599 $59,331 -$2,940* $24,314 $14,922 $1,286 2017 $61,141 $60,462 -$1,561 $27,954 $15,330 $3,612* 2018 $62,329 $64,756 -$4,853* $27,969 $15,356 $2,753* *p<0.05. The adjustment methodology accounted for patient demographic, clinical and area-level characteristics, and time-varying Hospital Service Area (HSA) level variables. For the DiD analysis, HSA fixed effects were also included.

Improving the approach to assessing the impact of financial market digitalization on the rationality of financial decisions

The object of research is the process of assessing the impact of digital transformations on the rationality of financial decisions (RFD) in the context of the functioning of modern financial markets. The problem being solved is to specify a scientifically sound approach to the integrated analysis of quantitative, qualitative and simulation characteristics, which allow for accurate determination of the effectiveness of digital technologies in the processes of financial decision-making, taking into account uncertainty, data limitations, behavioral factors and the level of digital literacy. It is proven that the growth of spending on digital technologies is closely correlated with the growth of the RDF level, which is confirmed by the results of multi-criteria analysis, ARIMA forecasting, Monte Carlo modeling and clustering. The effectiveness of the use of hybrid simulation models that combine system dynamics with an agent approach is determined, and indicators of digital sustainability of companies are also proposed. The recommendations developed to improve the approach to assessing the impact of digitalization of financial markets on RDF can be used by financial institutions, regulatory authorities and the corporate sector to assess the effectiveness of digitalization, increase the validity of financial strategies, reduce the level of risk, adapt to martial law conditions and strengthen competitiveness in the digital environment.

Effects of institutional quality and public expenditure on economic growth nexus in a small open economy

This research aims to analyze the influence of institutional quality on the relationship between economic growth and public expenditure in a small open economy. This research uses the autoregressive distributed lag (ARDL) methodology. The results showed that (1) institutional variables have a significant and positive moderating effect on the relationship between public spending and economic growth; (2) lending rates that are too high hurt economic growth because they keep the private sector from borrowing money; and (3) inflation rates that are too high hurt economic growth rates. In optimizing the moderating impact of institutional quality on the relationship between public expenditure and economic growth, the government should adopt policies that build strong institutions through consistency in upholding the rule of law. Specific and concrete policy recommendations include a need to address the endemic problem of corruption, boost the economy’s industrial productivity, stimulate private sector investment participation in the economy, moderate excessive lending rates, and encourage the crowding-in of the private sector so that the private sector can readily access funding for business expansion.

Candidate B-Roll as Super PAC Subsidy

Prior research theorizes that recent growth in outside election spending has undermined candidates’ ability to control the information received by voters. This paper explores how candidates have adapted to retain control over their visual presentation to voters in the face of competition with wealthy outside interests. Drawing on a new dataset of B-Roll video and image provision in congressional campaigns, I show that this strategy was employed more than 650 times in 390 U.S. House and Senate races from 2018–2022. These visual resources served as a novel form of subsidy for allied super PACs, lowering the cost of production for outside ads and encouraging outside involvement in congressional races. By matching candidate-provided visual resources to a dataset of 7881 political ads, I show that more than $116.5 million of “independent” outside advertising was subsidized through candidate B-Roll and image provision during the 2018 and 2020 cycles alone. This research indicates that candidates continue to prioritize - and wield significant control over - their visual presentation in political advertising despite regulatory and financial disadvantages.

Public Expenditure and Economic Growth: Estimation of Impact at the Local Level in Cities of Ecuador

Public spending and economic growth are analyzed from a global context, with productive dynamism, leading to an important separation between current spending (government operations) and investment spending (infrastructure). This investigation contributes to the vast amount of information and examines the correlation between public expenditure and economic growth at Ecuador's subnational level, using a panel of 19 cities from 2007-2019. A fixed-effects panel data standard estimates the influence of current and investment spending on the growth of per capita Gross Value Added. The results show that, in line with endogenous growth theory, public expenditure progressively and significantly affects economic growth. However, significant heterogeneity is observed in the effects of expenditures according to city size, with investment spending being more critical in larger cities and current expenditures in smaller towns. These findings highlight the importance of designing local fiscal policies adapted to each city's specific characteristics and promoting sustainable economic growth.

State Health Care Cost Commissions: Their Priorities and How States' Political Leanings, Commercial Hospital Prices, and Medicaid Spending Predict Their Establishment.

States are becoming increasingly concerned about rising health care spending because it crowds out budgets for education and other obligations and it burdens consumers, exposing them to medical debt and bankruptcies. This study identifies states that have established health care cost commissions (HCCCs), examines state-level political and economic factors associated with their establishment, and reports which of these states have also enacted health care competition-related laws that further equip these commissions. To identify states with HCCCs and competition-related laws, we reviewed prior reports, supplemented by our own research on state websites and from organizations that track state-level legislative and executive activity in health care. We estimated a regression model to understand how political and economic factors are related to these commissions being established. As of August 2024, 17 states had established HCCCs that aim to reduce the growth of health care costs using a variety of methods, such as collecting health care use and spending data and setting spending growth targets. States that lean politically Democratic were more likely to establish these commissions, particularly those states with higher commercial hospital prices or higher Medicaid spending as a share of the state budget, or both. States with HCCCs have also enacted competition-related laws but to varying degrees. Because health care reform is difficult to enact at the federal level, many states are enacting their own reforms, tailored to their needs and political feasibility with many establishing HCCCs to limit health care spending increases. Future research should study the impact of these commissions on health care spending that increases short-term spending yet moderates long-term spending, including the feasibility and impact of increased spending on primary care services as well as the impact of spending on new health care technologies.

Defense Spending, Conflict and Economic Growth in Europe

Abstract This study seeks to answer the following research question: How do defense spending and conflict impact economic growth in Europe, and what role does NATO membership play in shaping these dynamics? Using a panel dataset of 40 European countries from 1999 to 2023, the analysis investigates a change in security dynamics in Europe post-2014, determinants of military expenditure, whether NATO’s influence is more pronounced for countries closer to Russia, and how military expenditure and conflict impact economic performance. Employing panel econometric techniques, the analysis reveals that while military expenditure is not directly correlated with GDP per capita growth, conflict exerts a profoundly negative effect, with battle-related deaths significantly reducing economic performance. NATO membership is associated with increased defense spending, where geographical distance to Russia implies weakening of NATO countries’ military budgets. For NATO members, higher US military expenditure correlates with reduced European spending, highlighting reliance on American security provisions. The findings underscore the complex dynamics between defense allocations, alliance structures, and economic conditions, emphasizing the need for balanced policy approaches that address security imperatives without compromising long-term economic growth.

Does military spending really support economic growth in small island countries? a comparative study of five small island countries

ABSTRACT We investigate the long-run and short-run relationship between military spending and economic growth, using the augmented Solow framework for five small island countries. We apply Pesaran, et al’s ARDL bounds procedure and the Toda and Yamamoto’s Granger non-causality procedure, respectively. Structural break is identified from the Bai and Perron’s multiple break test. A positive contribution of capital per worker is noted for all five countries. We note that military expenditure is positive and significant in both the long and short run for Mauritius only, whereas for smaller countries like Fiji and Seychelles, the association is positive in the long run only. For the Dominican Republic, military expenditure is positive but not significant in the short-run, and there is a significant negative association in the long-run, indicating a growth-retarding effect. For Singapore, the coefficient of military expenditure per worker is positive but not statistically significant. Furthermore, capital stock causes military expenditure for the Dominican Republic, Fiji, and Mauritius, reverse causality is noted for Seychelles, and a bidirectional causality between the two is noted for Singapore. Capital causes output for Fiji and Mauritius, and a reverse causality is noted for Singapore. For Mauritius, military expenditure and output are mutually reinforcing each other.

Impact of the COVID-19 pandemic on the relationship between economic growth and health expenditure

ABSTRACT This study examines the relationship between health spending and economic growth across 158 countries from 1990 to 2022, with a focus on the impact of the COVID-19 pandemic, particularly from 2020 to 2022. The gross domestic product per capita (GDPC) growth rates increased across all income groups during 2020–2022, with rising health expenditure as a driver in middle- and low-income countries. Health expenditure positively impacts GDP per capita in middle- and low-income countries. However, health expenditure has a significantly rising trend in high-income countries (HIC), underscoring the importance of steady health investment for economic resilience. Upper middle-income countries (UMIC) benefit considerably over the long term, but pandemic-related effects are not significant and inconsistent, highlighting the need for adaptive spending and structural reforms in demographics, insurance systems, and poverty. Health spending supports growth in lower-middle-income (LMIC) and low-income countries (LIC) despite the COVID-19 disruptions. Economic growth also boosts health investment in HIC and UMIC during 2020–2022,2020, and 2022 in LMIC, suggesting mutual reinforcement, and does not find such effects in LIC. Adaptive spending and structural reforms are also required for demographics, insurance, and foreign direct investment in LMIC and LIC.

Analysis of the Effect of World Bank Loans, Foreign Direct Investment (FDI), Government Spending, and Economic Growth on Stock Market of ASEAN Countries in 2013-2022

This study aims to determine the effect of World Bank loans, Foreign Direct Investment (FDI), government spending, and economic growth on Stock Market performance in ASEAN countries for the period 2013-2022. Using the type of explanatory research with a quantitative approach, from secondary data obtained through literature studies and documentation studies with the Eviews 12 tool. The sample consists of 50 observations from 5 countries selected using purposive sampling technique, namely Indonesia, Thailand, Philippines, Vietnam, and Cambodia using multiple linear regression analysis. The results show partially that World Bank loans, Foreign Direct Investment (FDI), and government spending have an insignificant effect on the Stock Market, while economic growth has a significant effect with a positive relationship. Simultaneously, all four variables have a significant effect with a positive relationship on ASEAN stock market performance. This study suggests considering other variables that have more potential to influence the stock market performance of ASEAN countries.

Military expenditure and economic growth in African countries: the role of institutional quality

The objective of this paper is to analyze the role of institutional quality in the relationship between military spending and economic growth in sub-Saharan Africa. For this purpose, a dynamic panel model was specified and estimated by the generalized method of moments (GMM) in system. Using World Bank data (WDI) over the period 2002–2021, the model results showed that military spending has a positive and significant influence on economic growth in Africa. In addition, the estimation results reveal that institutional quality reinforces the positive influence of military spending on economic growth in Africa. Also, the estimation results of the interaction model by region show that the interaction between military spending and institutional quality is significantly positive on economic growth in the Economic Community of West African States (ECOWAS) and the Southern African Development Community (SADC). The study therefore suggests the implementation of austerity policies in order to improve institutional quality, a guarantee of better orientation of military expenditure towards productive sources.

Can Financial Inclusion Drive Leads to the Inclusive Growth? An Evidence from Pakistan.

This research investigates the effect of financial inclusion on inclusive growth in Pakistan. Based on a panel dataset from 2011 to 2024, the research uses a fixed-effects regression framework and robustness tests such as PCSE and Driscoll-Kraay techniques. The study uses digital financial inclusion indicators—coverage breadth, depth of use, and digitalization level—combined with human capital variables and important macroeconomic control variables of inflation, government spending, trade openness, and population growth. Findings reveal that financial inclusion plays a crucial role in economic growth, particularly if supported by the development of human capital. Policy recommendations are to improve digital infrastructure, raise financial literacy, and focus inclusion initiatives on under-served areas.

National trends in prescription drug expenditures and projections for 2025.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. To report historical patterns of pharmaceutical expenditures, to identify factors that may influence future spending, and to predict growth in drug spending in 2025 in the United States, with a focus on the nonfederal hospital and clinic sectors. Historical 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 2025 were reviewed-including new drug approvals, patent expirations, and potential new policies or legislation. Focused analyses were conducted for biosimilars, cancer drugs, endocrine drugs, generics, specialty drugs and vaccines. For nonfederal hospitals, clinics, and overall (all sectors), estimates of growth of pharmaceutical expenditures in 2024 were made based on a combination of quantitative analyses and expert opinion. In 2024, overall pharmaceutical expenditures in the US grew 10.2% compared to 2023, for a total of $805.9 billion. Utilization (a 7.9% increase) and new drugs (a 2.5% increase) drove this increase, while prices remained flat (a 0.2% decrease). Semaglutide was the top drug in 2024, followed by tirzepatide and adalimumab. Drug expenditures were $39.0 billion (a 4.9% increase) and $158.2 billion (a 14.4% increase) in nonfederal hospitals and clinics, respectively. In clinics, increased utilization drove growth, with a small contribution from new products, while prices remained flat. In nonfederal hospitals, new products, price, and new volume each contributed modestly to growth in spend. Several new drugs that will influence spending are expected to be approved in 2025. Specialty, endocrine, and cancer drugs will continue to drive expenditures. For 2025, we expect overall prescription drug spending to rise by 9.0 to 11.0%, whereas in clinics and hospitals we anticipate an 11.0% to 13.0% increase and a 2.0% to 4.0% increase, respectively, compared to 2024. These national estimates of future pharmaceutical expenditure growth may not be representative of any health system because of the myriad of local factors that influence actual spending.

Solvency extensions to the Medicare Hospital Insurance Trust Fund: what is driving them?

The annual Medicare Trustees Report projects when the Hospital Insurance Trust Fund will become insolvent, a key indicator of the Medicare program's fiscal health. Over the past 40 years, the Trust Fund insolvency date was extended 20 times. The Trustees estimated in 2012 that the Trust Fund would be completely exhausted by now; their latest estimate pushed the depletion date back to 2036. Our analysis of Medicare Trustees Reports from 1985 to 2024 revealed the factors affecting solvency projections. While annual adjustments to cost growth assumptions have triggered minor solvency extensions, major reforms such as the 1984 Deficit Reduction Act, 1997 Balanced Budget Act, and 2010 Affordable Care Act had larger, more sustained impacts than originally estimated. These policy reforms directly affected provider payments and indirectly constrained growth in other parts of the program, including payments to private health plans. In light of recent growth in US health spending, the challenge for policymakers seeking to improve Medicare's financial outlook is to enact and sustain substantive legislative changes rather than short-term solutions.

The nexus of localism on company performance in the modest fashion business in Indonesia

The growth of global Muslim consumer spending on halal-related commodities has significantly increased, with modest fashion emerging as a notable sector. Despite Indonesia's substantial Muslim population, the country remains a market rather than a leader in modest fashion exports, ranking ninth in exports to OIC countries. This study investigates how fashion localism—focusing on local production and cultural elements—affects company performance in Indonesia's modest fashion business. Using Structural Equation Modeling (SEM) with Partial Least Squares (PLS), the research explores the impact of perceptions and behaviors related to design, raw materials, land ethics, employee development, consumer engagement, regulations, future opportunities, community development, and promotion. The findings reveal that all these factors have a significant and positive influence on company performance. Specifically, perceptions of design and raw materials, as well as behaviors related to employee development and consumer engagement, strongly impact company outcomes. The study underscores the importance of incorporating fashion localism strategies, including effective promotional tactics and regulatory adaptation, to boost competitiveness and performance in the modest fashion sector. This research provides valuable insights for business stakeholders aiming to leverage local strengths and cultural elements to enhance market positioning and overall performance.