Total Cost Perspective Research Articles

Out-of-pocket expenditure and catastrophic costs due to COVID-19 in Indonesia: A rapid online survey.

The Corona Virus Disease 2019 (COVID-19) pandemic has created a substantial socioeconomic impact, particularly in developing countries such as Indonesia. This study aimed to describe the COVID-19-related out-of-pocket spending of Indonesian citizens and the proportion of whom experienced catastrophic health spending during the COVID-19 pandemic using the patient's perspective. We conducted a rapid cross-sectional online survey across provinces in Indonesia to capture participants' experiences due to COVID-19. Data were collected between September 23rd to October 7th of 2021 including demographics, income, and expenditures. Descriptive statistics were used to analyze the respondents' characteristics. Patients's perspective of total cost was estimated from out-of-pocket of COVID-19 direct costs and compared them to total expenditure. If the proportion of COVID-19 total costs exceeded 40% of the total expenditure, the respondents were deemed to have faced catastrophic costs. A total of 1,859 respondents answered the questionnaire. The average monthly income and expenditure of respondents were 800 USD, and 667 USD respectively. The monthly expenditure was categorized into food expenditure (367 USD) and non-food expenditure (320 USD). The average of COVID-19-related monthly expenditure was 226 USD, including diagnostic expenditure (36 USD), preventive expenditure (58 USD), medical expenditure (37 USD for COVID-19 treatment; and 57 USD for post-COVID-19 medical expenses), and non-medical expenditure (30 USD). Analysis showed that 18.6% of all respondents experienced catastrophic costs while 38.6% of the respondents who had COVID-19 treatment experienced catastrophic costs. The high proportion of catastrophic costs among respondents suggests the need for COVID-19 social protection, especially for COVID-19 diagnostic and prevention costs. The survey findings have led the government to increase the benefit coverage other than medical costs at the hospitals.

The vertical boundary for cross-border e-tailers’ logistics operations considering transaction costs

ABSTRACT This paper examines the effect of transaction costs on the vertical boundary and performance of in-house overseas warehouse logistics operations and outsourcing. So far, the total-cost perspective for an e-commerce company (e-tailer) has only been sketched conceptually, leaving a gap to close with quantitative formulations. This paper finds following points: First, no transaction cost considered can exaggerate not only profit but also the scale of the logistics operation, with a right shift of the vertical boundary for a cross-border e-tailer. Second, with an increase in logistics capacity, the scale of an e-tailer’s in-house logistics operation shrinks. Third, an increase in the service differentiation coefficient is beneficial to a cross-border e-tailer that hires a logistics integrator rather than handling logistics operations in-house. Fourth, an increase in the markup rate of in-house logistics production costs, compared to an external operation, can lead to a decrease in the vertical boundary.

Evaluating the Effectiveness of Life Without Parole as an Alternative to the Death Penalty

Death penalty in the United States has been steadily replaced by life without the possibility of parole (LWOP) sentences since 2001. As of July 2021, the number of people on death row imprisoned in state, federal, or military prisons was down to a thirty-year low, which translated to a 33% decrease since its peak in July 2001. On the other hand, the number of people serving LWOP increased by 66% since 2003. This paper reviews current academic literature to compare the pros and cons of LWOP and death penalty from financial and psychological points of view in response to the question of whether LWOP is a more effective alternative to the death penalty in the United States. From a total cost perspective, LWOP is less costly to execute than that of a death sentence. Psychologically speaking, LWOP may be more satisfactory for both families of the victims and defendants. However, while LWOP has been regarded by many as more humane, its effectiveness has been degraded by harsh policies in the 1980s and 1990, which have resulted in prison overcrowding and the United States having the highest prison incarnation rate in the world. In addition, diminishing rights is a common issue experienced by LWOP prisoners. Therefore, the author concludes that while LWOP has strengths over the death penalty, its ultimate effectiveness remains in question.

Cost-effectiveness of Same-day Discharge Surgery for Primary Total Hip Arthroplasty: A Pragmatic Randomized Controlled Study

BackgroundTotal hip arthroplasty (THA) causes a great medical burden globally, and the same-day discharge (SDD) method has previously been considered to be cost saving. However, a standard cost-effectiveness analysis (CEA) in a randomized controlled trial (RCT) is needed to evaluated the benefits of SDD when performing THA from the perspective of both economic and clinical outcomes.MethodsEighty-four participants undergoing primary THA were randomized to either the SDD group or the inpatient group. Outcomes were assessed by an independent orthopedist who was not in the surgical team, using the Oxford Hip Score (OHS), EuroQol 5D (EQ-5D), SF-36 scores and the quality-adjusted life years (QALYs). All the cost information was also collected.ResultsThe mean stay of patients in the SDD group was 21.70 ± 3.45 h, while the inpatient group was 78.15 ± 26.36 h. This trial did not detect any significant differences in OHS and QALYs. The total cost in the SDD group was significantly lower than that in the inpatient group (¥69,771.27 ± 6,608.00 vs. ¥80,666.17 ± 8,421.96, p < 0.001). From the perspective of total cost, when measuring OHS, the incremental effect was −0.12 and the incremental cost was –¥10,894.90. The mean incremental cost-effectiveness ratio (ICER) was 90,790.83. When measuring QALYs, the incremental effect was 0.02, and the ICER was negative. Sensitivity analysis produced similar results.ConclusionsSDD has an acceptable likelihood of being more cost-effective than the traditional inpatient option. After conducting cost–utility analysis, SDD resulted in better QALYs, while significantly reducing the total cost.

A total cost perspective of type 1 and 2 diabetes mellitus in two South African medical schemes servicing the public healthcare sector.

Diabetes is increasingly becoming a public health concern in South Africa (SA). There are limited available data on the costs of diabetes. To provide a total cost perspective of diabetes using medical scheme claims data from two SA medical schemes servicing the public healthcare sector in 2015 and 2016. We analysed data from 2 363 diabetes patients. Direct diabetes care costs included medication, consumables, hospitalisation and routine laboratory tests. Indirect costs were calculated by allocating economic costs related to disability-adjusted life years. The mean (standard deviation) age was 65.8 (13.4) years and women comprised 51% of the group. Hospitalisation (64.7% in 2015 and 65.5% in 2016) and medication (31.0% in 2015 and 21.1% in 2016) contributed the most to total direct costs. Total direct diabetes care costs mounted to ZAR2 452 per patient in 2015 and ZAR2 486 in 2016. Indirect costs were ZAR17 223 per patient in 2015 and ZAR18 711 in 2016. When direct and indirect costs were combined, the costs accrued to ZAR27.9 billion (ZAR19 675 per patient) in 2015 and ZAR29.9 billion (ZAR21 197 per patient) in 2016, representing 0.688% and 0.689% of the SA gross domestic product over the 2 years, respectively. Diabetes and its associated costs hold significant implications for the healthcare sector and the country's economy. Large numbers of diabetic individuals remain undiagnosed and the true costs of diabetes might even be higher.

Project Portfolio Selection Considering Total Cost of Ownership in the Automobile Industry

Project portfolio selection for developing a new product is critical to a company because the attributes of the project reflect on the price, quality, and functionality of the developed product. The market evaluates the developed product and the assessment of the product value determines its sale on the market. The project portfolio selection and sales are interconnected from a corporate perspective. The automobile industry is an industry which responds to the issue of business sustainability sensitively because their business directly relates to the environment. In this study, business sustainability was approached through the perspective of total cost of ownership (TCO) embedded into the project selection model after the attributes of the project, investment and efficiency, and the TCO of the product were combined to generate a sales function. The sales and revenue models were proposed, and the validity of the models was confirmed using a case from the automobile industry. As a result of the experiments, the sales model tended to show that the market share increased by selecting the proper number of projects to maximize sales. In contrast, the revenue model showed a tendency to select projects more than the sales model in order to maximize the profits of the company. By suggesting project selection models in a new perspective different from the ones in existing studies, this study is valuable with regard to the fact that the suggested models preserve project interrelationships, TCO, and product sales in a practical manner to enhance business sustainability.

Life Cycle Assessment of Environmental Impacts and Total Cost of Power Cable

For responding the national demand of energy conservation and emission reduction (ECER) and promoting the green purchase of power equipments, it’s highly of importance to perform the analytic process of environmental impacts and total cost in lifetime for power equipments. Life cycle assessment (LCA) is an analytic approach which completely supervises the concerned objective within its life cycle. In this paper the life cycle is hypothetically divided into three main phases, respectively, the production phase, the operation phase and the recycling phase. On the basis of LCA, this study develops a model regarding the environmental impact analysis and total cost calculation for power cable within its life cycle. This model computes the emission level of main pollutants at each stage and illustrates the trend of total cost change with respect to changeable power load parameters. The experimental research indicates that the developed model is practically useful and rational with conclusions. In terms of environmental impacts of power cable, the effect from the production phase mostly lies in the discharge of abundant waste water. And the effect from the operation phase mainly concentrates upon the energy consumption and the emission of greenhouse gas. However, the effect from the recycling phase is very slight. Meanwhile, as for the perspective of total cost of power cable, the operating cost increases obviously as the power load arises.

A Cost-benefit Analysis of Coal-based Power Enterprises Based on the Perspective of Total Cost

A Cost-benefit Analysis of Coal-based Power Enterprises Based on the Perspective of Total Cost

Doing well by doing good: A total-cost perspective on global supply chain sustainability risks

Stakeholders pay increasing attention to sustainability in global supply chains and are able to punish buying firms when they notice illegitimate conditions. Buying firms should therefore consider such supply chain sustainability risks in their decision-making; however, these important phenomena have hardly been studied. Moreover, practitioners do not yet have a

A total cost perspective on use of polymeric materials in solar collectors – Importance of environmental performance on suitability

To assess the suitability of solar collector systems in which polymeric materials are used versus those in which more traditional materials are used, a case study was undertaken. In this case study a solar heating system with polymeric solar collectors was compared with two equivalent but more traditional solar heating systems: one with flat plate solar collectors and one with evacuated tube solar collectors. To make the comparison, a total cost accounting approach was adopted. The life cycle assessment (LCA) results clearly indicated that the polymeric solar collector system is the best as regards climatic and environmental performance when they are expressed in terms of the IPPC 100 a indicator and the Ecoindicator 99, H/A indicator, respectively. In terms of climatic and environmental costs per amount of solar heat collected, the differences between the three kinds of collector systems were small when compared with existing energy prices. With the present tax rates, it seems unlikely that the differences in environmental and climatic costs will have any significant influence on which system is the most favoured, from a total cost point of view. In the choice between a renewable heat source and a heat source based on the use of a fossil fuel, the conclusion was that for climatic performance to be an important economic factor, the tax or trade rate of carbon dioxide emissions must be increased significantly, given the initial EU carbon dioxide emission trade rate. The rate would need to be at least of the same order of magnitude as the general carbon dioxide emission tax rate used in Sweden. If environmental costs took into account not only the greenhouse effect but also other mechanisms for damaging the environment as, for example, the environmental impact factor Ecoindicator 99 does, the viability of solar heating versus that of a natural gas heating system would be much higher.

On the optimal design of gas-expanded liquids based on process performance

Gas-expanded liquids (GXLs) are mixed solvents composed of an organic solvent and a compressible gas, usually carbon dioxide (CO2) due to its environmental and economic advantages. The best choice of GXL, as defined by the specific organic solvent and the CO2 composition, depends strongly on the process in which the solvent is to be used. Given the large range of possible choices, there is a need to predict the impact of GXL design on process performance from economic and environmental perspectives. In this work, we present a design methodology in which limited experimental data are used to build a predictive model which allows a wider design space to be assessed. The proposed methodology for the integrated design of CO2-expanded solvent and process is applied to the Diels–Alder reaction of anthracene and 4-phenyl-1,2,4-triazoline-3,5-dione (PTAD). Three organic co-solvents are studied: acetonitrile, methanol and acetone. Given that the process cost is sensitive to the operating pressure and reactor volume, a trade-off between reaction rate constant and solubility is required in order to design an optimal process from a cost perspective. From a total cost perspective and in terms of energy consumption, it is found that designs with small amounts of CO2 or, in the case of acetone, without any CO2, offer the best performance. However, CO2 use is found to lead to a significant reduction in organic solvent inventory, up to 70 % in some cases. In this work the importance of taking multiple performance criteria, including process metrics, into account when designing GXLs is demonstrated.

Research of The Energy Structure Strategy of Hebei Province Based on the Perspective of Total Cost

Research of The Energy Structure Strategy of Hebei Province Based on the Perspective of Total Cost

Analysis of Travel Times and CO2 Emissions in Time‐Dependent Vehicle Routing

Due to the growing concern over environmental issues, regardless of whether companies are going to voluntarily incorporate green policies in practice, or will be forced to do so in the context of new legislation, change is foreseen in the future of transportation management. Assigning and scheduling vehicles to service a pre‐determined set of clients is a common distribution problem. Accounting for time‐dependent travel times between customers, we present a model that considers travel time, fuel, and CO2 emissions costs. Specifically, we propose a framework for modeling CO2 emissions in a time‐dependent vehicle routing context. The model is solved via a tabu search procedure. As the amount of CO2 emissions is correlated with vehicle speed, our model considers limiting vehicle speed as part of the optimization. The emissions per kilometer as a function of speed are minimized at a unique speed. However, we show that in a time‐dependent environment this speed is sub‐optimal in terms of total emissions. This occurs if vehicles are able to avoid running into congestion periods where they incur high emissions. Clearly, considering this trade‐off in the vehicle routing problem has great practical potential. In the same line, we construct bounds on the total amount of emissions to be saved by making use of the standard VRP solutions. As fuel consumption is correlated with CO2 emissions, we show that reducing emissions leads to reducing costs. For a number of experimental settings, we show that limiting vehicle speeds is desired from a total cost perspective. This namely stems from the trade‐off between fuel and travel time costs.

Management Insights

Management Insights

Combining Bayesian Networks and Total Cost of Ownership method for supplier selection analysis

In this study, we analyze the supplier selection process by combining Bayesian Networks (BN) and Total Cost of Ownership (TCO) methods. The proposed approach aims to efficiently incorporate and exploit the buyer’s domain-specific information when the buyer has both limited and uncertain information regarding the supplier. This study examines uncertainty from a total cost perspective, with regards to causes of supplier performance and capability on buyer’s organization. The proposed approach is assessed and tested in automotive industry for tier-1 supplier for selecting its own suppliers. To efficiently facilitate expert opinions, we form factors to represent and explain various supplier selection criteria and to reduce complexity. The case study in automotive industry shows several advantages of the proposed method. A BN approach facilitates a more insightful evaluation and selection of alternatives given its semantics for decision making. The buyer can also make an accurate cost estimation that are specifically linked with suppliers’ performance. Both buyer and supplier have clear vision to reduce costs and to improve the relations.

Managing international supply: The balance between total costs and customer service

Many trading companies have taken a global approach to their supply markets, sourcing from low-cost foreign countries in order to achieve cost reductions. There remains, however, a lack of evidence that sourcing internationally actually leads to improved economic performance. This can be explained by two key challenges in terms of how to achieve a balance between: (1) purchasing and logistics costs, and (2) customer service. The purpose of this paper is to examine the organisation and management of international supply from a total cost perspective, taking into account both purchasing and logistics costs, as well as customer service and agility. Previous research into a number of Norwegian companies that have sourced from China has identified four configurations for managing international supply. This paper utilises the supply management literature and an example of a Norwegian retail and wholesale company to analyse and discuss these configurations and their effects on total costs and customer service. The paper's theoretical contribution is the conceptualisation of a total cost perspective on international supply management and the discussion of such costs in relation to customer service. This contribution may, in turn, aid companies that source from foreign, low-cost countries.

Cost-effectiveness analysis for integrated prevention of mother-to-child transmission of HIV

To evaluate the cost-effectiveness and economic efficiency of integrated prevention of mother-to-child transmission (PMTCT) of HIV in four high-incidence counties. Data of local resource investment and total cost for PMTCT in 4 counties in China from 2003 to 2006 were collected. Cost analysis and cost-effectiveness analysis were conducted. Average costs of a confirmed HIV case, a prevented case and a disability-adjusted life-year (DALY) saving were calculated. Average cost of identifying one HIV-infected mother was yen5512. Costs of a pediatric HIV case prevention and per DALY saving were yen46 747 and yen1870 ($231), respectively, based on the total cost perspective. The cost of integrated prevention of mother-to-child transmission of HIV was low. The PMTCT program was economical efficiency.

Prevention of Adenoviral Acute Respiratory Disease in Army Recruits:: Cost-Effectiveness of a Military Vaccination Policy

Introduction: Since 1971 widespread vaccination has limited the number of adenoviral acute respiratory disease (ARD) outbreaks in Army recruits. Increased vaccine costs have recently threatened the continuation of the vaccination program. Methods: We conducted a cost-effectiveness analysis to assess the consequences of changing the year-round Army adenovirus vaccination program to (1) seasonally targeted vaccine administration (only during the high-risk period) or (2) complete discontinuation of the program from the perspective of total cost to the Army. Costs included vaccination costs and direct and indirect medical and military training costs. Health outcomes were estimated as the number of hospitalizations for ARD prevented. In the reference case, the incidence rate among unvaccinated and vaccinated individuals was 4.06 and 1.5 per 100 person weeks, respectively. Results are expressed for a cohort of 76,171 recruits. Results: In the absence of adenoviral vaccination, a projected 12,370 cases of ARD hospitalization would occur, costing $26.4 million annually. A seasonally targeted program would prevent 7,800 cases of ARD and save $16.1 million over no vaccination. Year-round immunization would not prevent any additional cases but would save $15.5 million over no vaccination. Year-round vaccination would become the cost-effective strategy if ARD incidence during the low-risk months were to increase. Conclusion: Vaccination of Army recruits by any schedule was cost-saving due to the high level of prevented disease and averted hospitalizations. Even though a seasonally targeted program provided the greatest cost-savings, year-round vaccination must remain an option due to the potential for adenoviral ARD outbreaks in the low-risk period.

Merging C and assembly language in microcontroller applications

A number of microcomputer and microcontroller applications have small production runs or require quick prototyping to allow for concurrent development of other parts of the system which depend on functional, if not final, code. In these cases, the ease, speed, and reduced errors associated with coding the operating program in a high-level language justify its usage. The reduction in non-recurring engineering costs more than compensates for the increased recurring product costs and therefore makes sense from a total cost perspective. A model of the software design cycle is introduced here which considers software development as starting at the highest language level possible and only those sections of code which require streamlining for reasons of increased execution speed or reduced program storage being re-coded into assembly language. Examples are given of how to use the C language to directly address hardware components and memory and how to effectively link assembly language and C into a single functional program.