Spending Targets Research Articles

Uncertainty and Fiscal Policy in an Asymmetric Monetary Union

The paper examines the monetary-fiscal interactions in a monetary union model with uncertainty due to imperfect central bank transparency. We first show that monetary uncertainty disciplines fiscal policymakers and thereby reduces taxes, average inflation and output distortions. However, as more members enter the monetary union, the fiscal disciplining effect of uncertainty is mitigated. As a consequence, monetary union enlargement may lead to a more aggressive fiscal stance in some member countries, depending on their relative economic and political weights, on their government's spending target, and on the change in the degree of uncertainty that they experience with the enlargement.

The Global Fund expands its role

Since the Global Fund was established in 2002, it has expanded from 15 to 300 staff and plans to triple its current size by 2010, reaching a spending target of US$ 6 billion per year to meet projected demand. Single disease campaigns have recently come under fire for destroying health systems, but Kazatchkine argues that vertical funds can, in fact, strengthen health systems. He tells the Bulletin about his organization’s plans to finance health systems in developing countries while continuing to fund country programmes for AIDS, tuberculosis and malaria.

Congress and MedPAC Weigh Options for Medicare Physician Payment Reform

Congress and MedPAC Weigh Options for Medicare Physician Payment Reform

DAC Peer Review of the Netherlands

This review contains the Main Findings and Recommendations of the Development Assistance Committee (DAC) and the report of the Secretariat. It was prepared with examiners from Sweden and Japan for the Peer Review meeting held on 12 September 2006. The review welcomed the Netherlands’ strong commitment to policy coherence for development and to maintaining high levels of development aid. The Committee noted that the Netherlands gives strong attention to issues of aid quality and uses innovative approaches to enable recipient countries to lead their own development agenda. It identified a number of recommendations (e.g. continuing efforts towards geographic and sector concentration, ensuring that spending targets do not jeopardise the principles of aid effectiveness, developing a more coherent strategy with respect to private sector development, and developing overall aid effectiveness and conditionality strategies) to assist the Netherlands in pursuing its efforts to improve the effectiveness of its development co-operation programmes.

Wither Primary Care?

Wither Primary Care?

Wither Primary Care?

Wither Primary Care?

Medicare

No AccessPerspectives on Administration and SupervisionArticle1 Jun 2005MedicareThe Role of Medicare in Reimbursement Rosemary Griffin and Robert C. Fifer Rosemary Griffin Google Scholar More articles by this author and Robert C. Fifer Mailman Center for Child DevelopmentMiami, FL Google Scholar More articles by this author https://doi.org/10.1044/aas15.2.8 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationTrack Citations ShareFacebookTwitterLinked In References Government Accountability Office. (2004, May). Medicare physician payments—Information on spending trends and targets. Retrieved May 5, 2004, from http://www.gao.gov/new.items/d04751t.pdf Google Scholar Medicare program: Revisions to payment policies under the physician fee schedule for calendar year 2005.Code of Federal Regulations, 69, No. 219, pp. 66235–66916, 2004, Nov. Google Scholar U.S. Department of Health and Human Services. (2005). Effects of health care spending on the U.S. economy. Retrieved April 14, 2005, from http://aspe.hhs.gov/health/costgrowth Google Scholar Additional Resources FiguresReferencesRelatedDetails Volume 15Issue 2June 2005Pages: 8-10 Get Permissions Add to your Mendeley library History Published in issue: Jun 1, 2005 Metrics Topicsasha-topicsleader-topicsasha-sigsasha-article-typesCopyright & Permissions© 2005 American Speech-Language-Hearing AssociationPDF DownloadLoading ...

One problem at a time. Building research capacities in developing countries is necessary for economic success in the long term. But the numerous problems in doing so have to be solved for each country individually.

Building research capacities in developing countries is necessary for economic success in the long term. But the numerous problems in doing so have to be solved for each country individually

Congress Shifting Position on Medicare Payment Increases

Back to table of contents Previous article Next article Government NewsFull AccessCongress Shifting Position on Medicare Payment IncreasesKate MulliganKate MulliganSearch for more papers by this authorPublished Online:5 Jul 2002https://doi.org/10.1176/pn.37.13.0002Congress is moving toward an increase in Medicare payments for doctors, hospitals, and health maintenance organizations.The Bush administration’s insistence that any increase in Medicare reimbursement rates for physicians must result in corresponding decreases in other Medicare provider spending had the potential for pitting various segments of the health care system against each other (Psychiatric News, March 1, April 5, May 3).Health care professionals, however, worked together to pressure Republicans to renounce the Bush administration’s insistence on budget neutrality.Sam Goldreich of CQ Daily Monitor told www.kaisernetwork.org that the reversal came about because “House Ways and Means Chair Bill Thomas [R-Calif.] and House Energy and Commerce Chair Billy Tauzin [R-La.] decided not to play Bush’s zero-sum game for Medicare providers.“Instead, they promised rank-and-file Republicans that not only would hospitals get increases, but they would change current law that would have cut [payments to] doctors, nursing homes, and home health operators.”Hospitals Fight BackLast March Tommy Thompson, secretary of the Department of Health and Human Services, and Mitchell Daniels Jr., director of the Office of Management and Budget, proposed that increases to physicians be offset by “savings from. . .measured changes in hospital payment updates” (Psychiatric News, May 3).In a response dated March 26 to the administration’s proposal, a coalition of eight organizations representing hospitals wrote, “More than half [the hospitals] lose money treating Medicare patients. Fully one-third are losing money overall. And, without corrective action, $21 billion in additional reductions will be implemented by October 1, 2002.”The June 5 New York Times reported that a “quiet rebellion by rank-and-file House members, including many from New York, forced House Republican leaders to reverse themselves [about the proposed cut].”The Times reported that Republican leaders had reached an agreement to increase Medicare payments to hospitals by $9 billion over the next 10 years instead of cutting payments by $17 billion.On June 5 www.kaisernetwork.org reported that hospital groups had written letters in praise of the agreement.An analysis by the AMA, however, points out that the Thomas-Tauzin proposal would only slow currently scheduled reductions in payments for graduate medical education.More Money for DoctorsThomas and Tauzin have also proposed increasing Medicare payments to doctors by $20 billion over five years.According to an analysis of the proposal by the AMA, beginning in 2003 and extending through 2005 physicians would receive annual payment increases of approximately 2 percent, as compared with the current projected cuts of 5.7 percent in 2003, 5.7 percent in 2004, and 2.8 percent in 2005.The 2002 payment cut of 5.4 percent would remain unchanged.In 2006 physician payments would again be cut, as the proposal is now constituted. According to the AMA, Thomas and Tauzin have agreed to work toward a more permanent solution that would avoid those cuts.The AMA is continuing to urge the Centers for Medicare and Medicaid Services to make administrative changes that would eliminate or soften cuts under the current formula. For example, in 1998 and 1999 Medicare officials set spending targets too low and left the costs of more than 1 million beneficiaries out of the system. They also erroneously include the costs of physician-administered drugs when calculating costs of services (Psychiatric News, June 7).Fixing those errors could restore $62 billion over 10 years to the pool available to make payments to physicians, according to the AMA analysis.Jay Cutler, J.D., director of APA’s Division of Government Relations, said, “The AMA deserves thanks and praise for helping to demonstrate what a powerful force medicine can be when its practitioners present a united front. The proposal is a good step in the right direction, although it does not offer all that medicine deserves.”Other winners in the Thomas-Tauzin proposal are managed care companies. The proposal would increase payments to insurance companies that administer Medicare+Choice, the Medicare managed care option.AARP, formerly the American Association of Retired Persons, is worried that seniors will pay the price for increases to health care providers. David Certner, director of federal affairs at AARP, said that the proposal would mean “less money for drug benefits in a pot that was already insufficient,” according to the Times.Goldreich told www.kaisernetwork.org that Thomas and Tauzin “swear it isn’t [coming from the prescription drug benefit].”The committee chairs claim that their proposal for a prescription drug benefit would produce a cut in the cost of prescription drugs for seniors of 30 percent. The savings would be the result of promoting competition among private health insurance companies that would offer policies to cover drugs only and by encouraging them to negotiate discounts with the drug companies.“Medicare Physician Payment Update Background and Talking Points” is posted on the Web at www.ama-assn.org/ama/pub/article/6930.Numerous reports on Medicare are posted at www.kaisernetwork.org/daily_reports/rep_index.cfm. ▪ ISSUES NewArchived

After Wanless

New EconomyVolume 9, Issue 1 p. 16-20 After Wanless Health outcomes and spending targets Liz Kendall, Liz Kendall Institute for Public Policy ResearchSearch for more papers by this author Liz Kendall, Liz Kendall Institute for Public Policy ResearchSearch for more papers by this author First published: 17 December 2002 https://doi.org/10.1111/1468-0041.00233AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume9, Issue1March 2002Pages 16-20 RelatedInformation

APA-Backed Bill Would Head Off Medicare Fee Cuts

Back to table of contents Next article Government NewsFull AccessAPA-Backed Bill Would Head Off Medicare Fee CutsKate MulliganKate MulliganSearch for more papers by this authorPublished Online:7 Dec 2001https://doi.org/10.1176/pn.36.23.0001To lend weight to a Senate bill that would protect physician Medicare reimbursement rates, APA has joined more than 40 other medical associations to support the Medicare Physician Payment Fairness Act (S 1660).The bill is sponsored by Sens. Jim Jeffords (I-Vt.) and John Breaux (D-La.). It was introduced in the House of Representatives last month.The impetus for the proposed legislation was the announcement on October 31 by the Centers for Medicare and Medicaid Services (CMS) that the factor used to update payment rates for individual medical services will go down by 4.8 percent next year, and the conversion factor will be even lower, at 5.4 percent below the 2001 level.Jay Cutler, J.D., APA’s government relations director, told Psychiatric News, “The negative payment update problem is particularly acute for psychiatrists, who must also contend with underlying limitations in the Medicare program on reimbursement for psychiatric services, such as Medicare’s discriminatory 50 percent copayment requirement. APA is joining the AMA and all of medicine in efforts to correct the problem this year.”In an interview, Edward Gordon, M.D., chair of the APA Medicare Advisory Committee, emphasized the harmful effect the decrease could have on patient care. “Already many psychiatrists are unwilling or unable to take Medicare patients under the current fee schedule,” he said. “In New York, for example, Medicare payment is one-third to one-half lower than the prevailing rate for psychiatrists. It is a particularly difficult time to decrease the availability of mental health services when the whole country is under stress.”In announcing the physician payment changes, CMS Administrator Tom Scully said, “The law designing the physician update is incredibly prescriptive.The formula locks us in.”Unless Congress acts to change the formula or delay its implementation, the cuts will take effect on January 1, 2002. In fact, although CMS and medical associations differ on whether the formula has been beneficial to physicians, both sides agree that the federal government currently has little latitude in terms of implementation.The intent of the complex formula that determines physician reimbursement for treating Medicare beneficiaries is to change payment rates annually to reflect changes in physician practice costs. But, in addition to costs, the formula must also consider a target: the sustainable growth rate (SGR).The target is based on four factors: gross domestic product (GDP), enrollment in the traditional Medicare program, input prices, and spending due to new laws or regulations.When actual spending in a given year is inconsistent with the previously established target, the next year’s update must be adjusted to bring spending in line. In 2001 revisions to previous year estimates of GDP, increases in physician spending, and the economic slowdown produced the average decrease of 5.4 percent in physician rates for 2002.Congress adopted the Medicare fee formula as part of the Balanced Budget Act of 1997. CMS claims that the formula worked well for physicians between 1998 and 2001. The cumulative increase was 15.9 percent, which CMS compares with a medical-cost inflation increase of 9.3 percent.In their letter supporting the new legislation, however, the medical association signatories charge, “[The 2002 decrease] would be the fourth broad-scale reduction in physicians’ and other practitioners’ fees since 1992 and would bring the average increase in Medicare fees between 1991 and 2002 down to just 1.1 percent a year, or 13 percent less than the government’s own estimate of practice cost inflation.”The November 19 issue of American Medical News reports, “In 1998, when the SGR was introduced, GDP growth for both the current and upcoming year was underestimated by 2 percent. That has lowered the spending target by billions of dollars, increasing the magnitude of the reduction.”That same issue also reports that nearly 30 percent of family physicians are not accepting new Medicare patients.The most immediate impact of the Medicare Physician Payment Fairness Act would be to trim the decrease in physicians’ rates from 5.4 percent to .9 percent in 2002. In addition, the bill also would require the Medicare Payment Advisory Commission to conduct a study on replacing the SGR as a factor in determining the update for physician payments with a factor that more accurately reflects changes in the costs of providing physicians’ services. The bill has been referred to the Senate Finance Committee, which has not yet acted on it.The final rule describing revisions to payment policies under the Medicare physician fee schedule for calendar year 2002 can be found at www.hcfa.gov/regs/pfs/. The text of the Medicare Physician Payment Fairness Act can be accessed on the Web at thomas.loc.gov by searching on “S 1660.” ▪ ISSUES NewArchived

European defence: The cost of partial integration

In the last decade, European defence has undergone impressive changes. Military alliances between EU member countries have strengthened, and a European defence industrial base is building up. But in a paradoxical way, European countries look less capable of coping with important military crises, and their defence budgets are plunging. This paper proposes an explanation for this changing configuration, considering the case of the decentralized production of a public good with cross‐border spillin effects. In this context, increased reliability on allies may lead one country to lower defence expenditures and supply. Citizens would welcome an increase in defence production, but this outcome might be achieved only by a centralized production of defence services. A temporary pragmatic solution would consist in assigning appropriate minimum defence spending targets to EU member countries.

Section II The forecast in detail

It now seems likely that the economy will grow by just over 3 per cent in 2000, although the fuel crisis has obscured the picture to some extent. The latest retail sales figures indicate strong growth in high street spending, with the three months to September 1.6 per cent higher than the previous three months and 4.3 per cent higher than the same period in 1999. Second quarter government consumption increased by 1.9 per cent to recover from the fall in the first quarter. This accelerated growth is needed to meet spending targets. Our forecast is for an overall 2 per cent growth rate in the current year rising to 4 per cent next year. Gross fixed investment was some 6 per cent higher in 1999 over the previous year, and we are forecasting this to slow to 21h per cent for the current year, rising to 5 per cent for the next two years. Inventory accumulation should recover from the de-stocking evident last year.

Budget surplus isn't translating into R&D windfall

Fiscal 1999 money bills are finally shaking loose in Congress. Appropriations bills are supposed to move from the House to the Senate, but this year the Senate—tired of the House's inability to agree on even preliminary spending targets— started the ball rolling. And along with the money bills, just as day follows night, come congressional earmarks-money set aside for specific research projects or facilities in someone's home state or district. So far, the Senate has approved fiscal 1999 budgets for a number of the major research support agencies, including the largest: the Departments of Defense, Agriculture, and Energy; the National Science Foundation; the National Aeronautics & Space Administration; and the Environmental Protection Agency. The Senate has taken a bite out of only one research budget, but it's a big chunk. Funding for DOD research, development, test, and evaluation (RDT&E) programs would fall 4.7% to $36.1 billion. Fighting the overall downward trend, the Navy's RDT&E budget ...

Portfolio Management in New Product Development: Lessons from the Leaders—II

OVERVIEW:Three goals were revealed by a study of portfolio management practices in industry: maximizing the value of the portfolio, achieving the right balance and mix of projects, and linking the portfolio to the strategy of the business. The first two goals were examined in the September–October 1997 issue of RTM (1). This second article describes several methods for realizing the third goal, including a strategic “buckets” model, a top-down method for setting spending targets, a bottom-up scoring scheme that emphasizes strategic criteria, and the strategic check, which incorporates elements of both. In the ideal portfolio management process, three decision processes must work together: the strategy of the business drives both the portfolio review (and various portfolio models) as well as the gates or decision points in the business's Stage-Gate new product process. The gating process and the portfolio methods feed each other, and all three must be integrated.

Economic gender injustice: the MACRO picture

VIVIENE TAYLOR critically reviews the macro-economic policy of Government, business and labour from a gender perspective. She warns that the prescriptions for cuts in social spending and ambitious growth targets spell disaster for nearly 60 percent of women, who earning no income at all, will gain nothing from the formal market economy

Economic Gender Injustice: The Macro Picture

VIVIENE TAYLOR critically reviews the macro-economic policy of Government, business and labour from a gender perspective. She warns that the prescriptions for cuts in social spending and ambitious growth targets spell disaster for nearly 60 percent of women, who earning no income at all, will gain nothing from the formal market economy

Note on ‘Loss of monetary discretion in a simple dynamic policy game’

Jensen (1994a) finds that loss of monetary discretion leads to lower welfare. However, by extending his model we show that if real base money holdings are relatively low, as is likely to be the case for modern economics, a zero-inflation rule may well be preferable to monetary discretion. If the emphasis on achieving the output and public spending targets falls, a zero-inflation rule is more likely to be preferred. The increased support for binding policy rules thus conforms with a less tolerant attitude towards inflation.

Targeting nominal income: A closer look

I derive conditions under which the monetary authority should target nominal spending. The relevant spending target is a weighted average of income and consumption. Despite ‘sticky’ nominal wages, under optimal policy the economy behaves as if all markets clear.

Constraint or Accommodation

Have the congressional budget committees' spending targets provided stringent budget constraints for appropriators? That is, are these budget targets below or above the levels that appropriators would have agreed to in the absence of the budget process? The author estimates a model based on appropriations data from before budget reforms were enacted to forecast budget appropriations figures in the postreform era. He then compares these predicted budget figures with actual Budget Committee targets (602[b] suballocations) to assess the degree of budget restraint. The author concludes from the analysis that the budget process has not generally operated as a procedural spending restraint on House appropriators, although the targets have been constraining in the early 1990s and have served a partisan role for congressional Democrats in redirecting spending priorities from defense to domestic nondefense appropriations.