Total Expenses Research Articles

Influence of Not-for-Profit Hospital Ownership Type on Community Benefit and Charity Care.

Non-profit hospitals are expected to provide charity care and other community benefits to adjust their tax exemption status. Using the Medicare Hospital Cost Report, American Hospital Association Annual Survey, and the American Community Survey datasets, we examined if church-affiliated hospitals spent more on charity care and community benefit. For this analysis, we defined five main categories of community benefits were measured: total community benefit; charity care; Medicaid shortfall; unreimbursed other means-tested services; and the total of unreimbursed education and unfunded research.Multiple regression was used to examine the effect of church ownership, controlling for other factors, on the level of community benefit in 2644 general acute care non-profit hospitals. Descriptive analyses and multiple regression were used to show the relationship between the provision of community benefits and church affiliation including Catholic (CH), other church-affiliated hospitals (OCAH), and non-church affiliated hospitals (NCAH). The non-profit hospital on average spent 6.5% of its total expenses on community benefits. NCAH spent 6.09%, CH spent 7.5%, and OCAH spent 9.4%. Non-profits spent 2.8% of their total expenses on charity care, with the highest charity care spending for OCAH (5.2%), followed by CH (3.9%), and NCAH (2.4%). Regression results showed that CH and OCAH, on average, spent 1.08% and 2.16% more on community benefits than NCAHs. In addition, CH and OCAH spent more on other categories of community benefits except for education and research. Church-affiliated hospitals spend more on community benefits and charity care than non-church affiliated nonprofit hospitals.

Transportation Route Optimization of Municipal Solid Waste Using Network Analyst Tool, Case of Jimma Town, Southwestern Ethiopia

Municipal solid waste transportation and collection account for the largest portion of its total management expenses. The current study intends to distribute solid waste collection bins and improve the municipal solid waste transportation routes for Jimma town, southwest Ethiopia, using the Network Analyst tool. The coordinates of each municipal solid waste collection container, the coordinates of the disposal location, the town's master plan, its population, the rate at which solid waste is produced, and the road shapefile are the data used for the study. The major piece of software used in this investigation was Network Analyst, an extension of ArcGIS. The recommended quantity of solid waste collection containers, the designated site for the containers, and the most efficient route are among the findings. The calculation's outcome showed that there were 66 municipal solid waste (MSW) collection containers for the 2018 calendar year and 110 containers after 20 years. 17.94 km is the optimal average distance to move filled containers from individual collection container locations to the disposal site and empty containers to their destination. Therefore, route design for municipal solid waste collection vehicles within the urban region is advised by the urban authorities.

Out-of-Pocket Health Expenditure Among Migrant Workers in India: A Narrative Review.

Migrant workers make significant contributions to host regions and economies in many nations, frequently working in vulnerable situations in crucial sectors like agricultural and food processing, transportation, health care, and construction sectors. India has one of the world's highest out-of-pocket spending rates, with a cost making up about 62.6% of total health expenses. Migrant workers face healthcare financing burdens due to medical expenses resulting in large out-of-pocket payments. This narrative review aims to gain insight into why migrant workers face out-of-pocket expenditures on health and explore the inclusion of migrant workers in the existing healthcare system in India. For the literature search, databases like PubMed and Google Scholar were used to find relevant articles. This review will be helpful from the public health perspective in illustrating the need for studies and research on the health rights of migrant workers, their healthcare finances, and the social protection of such vulnerable populations who are poor and marginalized. Due to various health disparities, migrant workers may incur unforeseen out-of-pocket costs for the household healthcare system. Health insurance enhances the likelihood of accessing healthcare and minimizes out-of-pocket expenses on inpatient services. Patients' visits to primary healthcare facilities are not increased by health insurance; hospitals remain the primary healthcare provider. Most interstate migrant workers remain unprotected and burdened by the cost of healthcare due to OOP payments in case of medical emergencies. The legal status is a crucial predictor of migrants' access to affordable and adequate health care in a country.

Synergizing Inventory and Distribution Supply Chain: An Integrated Framework

This study/research delves into an integrated approach to inventory management, shedding light on various inventory management technologies applicable across different industries and distribution systems. The overarching goal is to attain a competitive edge by reducing costs and enhancing service quality. It underscores the significant impact of total logistics costs, encompassing transportation, facility, and inventory expenses, on a company's competitiveness. By harmonizing inventory and distribution policy decisions, businesses can streamline costs and enhance their ability to respond effectively to market demands. The effectiveness of this integration is illustrated through a practical example involving a scenario of single supply and multiple demands. Moreover, the study examines the pivotal role of Vendor Managed Inventory in optimizing inventory management throughout the supply chain. Additionally, it explores the utilization of the Traveling Salesman Problem to streamline transportation expenses. Through the adoption of this integrated approach, organizations can realize cost efficiencies and bolster their responsiveness, ultimately strengthening their competitive position within the industry.

Plant design of biodiesel production from waste cooking oil in Malaysia

In this study, a techno-economic, risk and safety assessment of biodiesel generation from waste cooking oil through alkali-catalyzed transesterification process had been conducted. The optimized results indicated that 1026 kg h−1 of biodiesel was produced from 1050 kg h−1 of waste cooking oil. Glycerol, the by-product was utilized to produce nitro-glycerine. The total capital expenses were expected to be US$9.62 million, while the total operating expenses were $11.16 million. The plant was economically viable with the simple pay-back period of 6.64 years. Furthermore, a detailed risk assessment and HAZOP were performed.

The Value of Having a Public Transit Travel Choice

The value of having a public transit travel choice is occasionally acknowledged by planners but never quantified; this paper provides a methodology to quantify it. This value of having a public transit choice is in addition to public transit’s benefits to users and non-users as a result of the improved performance of other modes in the transportation system resulting from the public transit investment. The value of choice accrues to the total population that has access to public transit, not just those who chose to use it or those who benefit because others have chosen it. This paper develops a methodology and a crude but plausible estimate of the value of choice for public transit using data describing features of U.S. daily personal travel in 1995. For perspective, this estimate is compared with the total operating and capital expense of providing public transit in the United States. The result indicates that the value of choice alone is comparable in magnitude to the cost of providing public transit in this country.

Effect of Influenza Vaccine on Prevention of Acute Attack of Chronic Airway Disease in Elderly Population.

This study investigated the effect of influenza vaccination on prevention of acute attacks in elderly patients with chronic airway disease and provides evidence for the prevention and control strategy of chronic airway disease in the elderly population. A total of 348 elderly patients in Linquan County, Anhui Province, China, who were also in stationary phases of chronic airway disease and were vaccinated with either the tetravalent or trivalent influenza vaccine were selected. The number of patients with acute attacks, the number of outpatients with acute attacks, the number of outpatients, the number of inpatients, the total cost of patients, the cost of outpatients, the cost of hospitalization, and the length of hospitalization were collected before vaccination and after a one-year follow-up. There was no significant difference in age and sex ratio among the two vaccination groups. The ratios of acute attacks, outpatient visits, and hospitalizations and number of outpatient visits, number of hospitalizations, total medical expenses, outpatient expenses, and hospitalization expenses were significantly higher before vaccination than those after vaccination in both the trivalent-vaccination group and tetravalent-vaccination group. Additionally, there was no significant difference in the length of stay between before and after vaccination in either the trivalent-vaccination group or tetravalent-vaccination group. The protection effect between the trivalent-vaccination group and tetravalent-vaccination group was not significant. Influenza vaccination can effectively prevent the acute attack of chronic airway disease and delay the progress of chronic airway disease.

Early Eculizumab Withdrawal in Patients With Atypical Hemolytic Uremic Syndrome in Native Kidneys Is Safe and Cost-Effective: Results of the CUREiHUS Study

The introduction of eculizumab has improved the outcome in patients with atypical hemolytic uremic syndrome (aHUS). The optimal treatment strategy is debated. Here, we report the results of the CUREiHUS study, a 4-year prospective, observational study monitoring unbiased eculizumab discontinuation in Dutch patients with aHUS after 3 months of therapy. All pediatric and adult patients with aHUS in native kidneys and a first-time eculizumab treatment were evaluated. In addition, an extensive cost-consequence analysis was conducted. A total of 21 patients were included in the study from January 2016 to October 2020. In 17 patients (81%), a complement genetic variant or antibodies against factor H were identified. All patients showed full recovery of hematological thrombotic microangiopathy (TMA) parameters after the start of eculizumab. A renal response was noted in 18 patients. After a median treatment duration of 13.6 weeks (range 2.1-43.9), eculizumab was withdrawn in all patients. During follow-up (80.7 weeks [0.0-236.9]), relapses occurred in 4 patients. Median time to first relapse was 19.5 (14.3-53.6) weeks. Eculizumab was reinitiated within 24 hours in all relapsing patients. At last follow-up, there were no chronic sequelae, i.e., no clinically relevant increase in serum creatinine (sCr), proteinuria, and/or hypertension in relapsing patients. The low sample size and event rate did not allow to determine predictors of relapse. However, relapses only occurred in patients with a likely pathogenic variant. The cost-effectiveness analysis revealed that the total medical expenses of our population were only 30% of the fictive expenses that would have been made when patients received eculizumab every fortnight. It is safe and cost-effective to discontinue eculizumab after 3 months of therapy in patients with aHUS in native kidneys. Larger data registries are needed to determine factors associated with suboptimal kidney function recovery during eculizumab treatment, factors to predict relapses, and long-term outcomes of eculizumab discontinuation.

Identifying Characteristics Associated with the Concentration and Persistence of Medical Expenses among Middle-Aged and Elderly Adults: Findings from the China Health and Retirement Longitudinal Survey.

Medical expenses, especially among middle-aged and elderly people, have increased in China over recent decades. However, few studies have analyzed the concentration or persistence of medical expenses among Chinese residents or vulnerable groups with longitudinal survey data. Based on the data of CHARLS (China Health and Retirement Longitudinal Study), this study sought to identify characteristics associated with the concentration and persistence of medical expenses among Chinese middle-aged and elderly adults and to help alleviate medical spending and the operational risk of social medical insurance. Concentration was measured using the cumulative percentages of ranked annual medical expenses and descriptive statistics were used to define the characteristics of individuals with high medical expenses. The persistence of medical expenses and associated factors were estimated using transfer rate calculations and Heckman selection modeling. The results show that total medical expenses were concentrated among a few adults and the concentration increased over time. People in the high medical expense group were more likely to be older, live in urban areas, be less wealthy, have chronic diseases, and attend higher-ranking medical institutions. Lagged medical expenses had a persistent positive effect on current medical expenses and the effect of a one-period lag was strongest. Individuals with chronic diseases during the lagged period had a higher likelihood of experiencing persistent medical expenses. Policy efforts should focus on preventive management, more efficient care systems, improvement of serious illness insurance level, and strengthening the persistent protection effect of social medical insurance to reduce the high medical financial risk and long-term financial healthcare burden in China.

Impact of Bank Efficiency on the Profitability of the Banks in India: An Empirical Analysis Using Panel Data Approach

This study aims to determine the impact of banking efficiency on the profitability of the Indian banking division. The ratios (key variables) used in the study are mentioned by the Reserve Bank of India—RBI (Central bank of India). Through a quantitative approach, pooled panel regression, univariate analysis, correlation, and descriptive statistics models are used by taking annual data of the Indian banking division from 2001 to 2020 available on the Thomson Reuters (Refinitiv) Database. Unbalanced cross-sectional data (panel data) comprising 527 bank-year observations for 33 Indian banks were studied. It was decided to evaluate the impact of efficiency (cost to income ratio and staff expenses to total expenses ratio) on the profitability (return on assets and net interest margin ratio) of the banks from the Indian banking division. The results revealed that the cost to income ratio has a significant negative impact on the bank return on assets and net interest margin ratio. The staff expenses to total expenses ratio has a significant positive impact on the bank return on assets and a positive nonsignificant impact on the bank net interest margin ratio.

ANALYSIS OF THE STRUCTURE OF THE LIST OF ANTIBIOTICS USED IN PHONG DIEN DISTRICT HEALTH CENTER IN 2019

Background: Antibiotics administered incorrectly may result in detrimental consequences, such as prolonging treatment duration, causing adverse effects, or even increasing mortality. Similar to surrounding underprivileged urban medical institutions, the Drug and Therapeutics Committee (DTC) at Phong Dien district's health center (PDHC) is still struggling to attain rationality in keeping track of and evaluating hospital medication formularies. It is commonly believed that these lists directly impact the DTC's decisions on drug selection, distribution, and order for supply, as well as other inventory issues such as assuring quality and minimizing extra expenses. Objectives: The research aimed to examine the characteristics of the antibiotics list utilized at PDHC in 2019. Methods: From January to December 2019, we investigated 99 different medicines from 8 different antibiotic families in retrospective research. The acquired data were analyzed statistically using descriptive analysis. Results: Foreign medications accounted for 19.3% of pharmaceutical expenditure, whereas domestic medicine accounted for 80.7%. Regarding route of administration, ratios of oral medicines dominated others in quantity and cost (67.67% and 82.73%, respectively). It also revealed that 97.27% of the inventory budget was spent on generic medications compared to under 3% of brand-name ones. Additionally, single-component products (78.79% of items and 71.65% of total expense) were used more often than those with multicomponents. β-lactam was the most widely utilized group among the 8 studied groups, which accounted for 72.61% of the monetary allocation. Conclusion: The results of this study showed that the use of antibiotics at the center was relatively adequate and followed the principle of drug consumption by the Ministry of Health (MOH) in drug utilization and prescription of antibiotics.

Worse Outcomes After Readmission to a Different Hospital After Sepsis: A Nationwide Cohort Study

BackgroundIn the United States, sepsis accounts for 13% of the total hospital expenses and > 50% of hospital deaths. Moreover, people with sepsis are more likely to be readmitted. ObjectiveThe aim of this study was to assess the prevalence and outcomes of different hospital readmissions (DHRs) in patients with sepsis, and the factors associated with DHR. MethodsWe used data from the Nationwide Readmissions Database of the United States in 2017 to identify patients admitted for sepsis. Multivariable logistic regression analysis was used to evaluate the factors associated with DHR; five models were constructed to elucidate the relationship between DHR and in-hospital outcomes. ResultsIn 2017, 85,120 (21.97%) of all patients with sepsis readmitted within 30 days in the United States were readmitted to a different hospital. The most common reason for readmission was infection irrespective of hospital status. Compared with the patients with sepsis who were readmitted to the same hospital, DHR was associated with higher hospitalization costs ($2264; 95% CI $1755–$2772; p < 0.001), longer length of stay (0.58 days; 95% CI 0.44–0.71 days; p < 0.001), and higher risk of in-hospital mortality (odds ratio 1.63; 95% CI 1.55–1.72; p < 0.001). ConclusionsDHR occurred in one-fifth of patients with sepsis in the United States. Our findings suggest that patients readmitted to a different hospital within 30 days may experience higher in-hospital mortality, longer length of stay, and higher hospitalization costs. Future studies need to examine whether continuity of care can improve the prognosis of patients with sepsis.

Dental use and medical expenses for endodontic diseases under the National Health Insurance System in Taiwan from 1998 to 2020

Background/purpose: The development of endodontology or endodontic treatment technology in Taiwan has a history of at least 100 years. This study investigated the dental use and medical expenses for endodontic diseases under the National Health Insurance (NHI) system in Taiwan from 1998 to 2020. Materials and methodsThe population data and medical records of the NHI system were obtained from the websites of Ministry of the Interior and the NHI Administration, respectively. The dental patient data for endodontic diseases were analyzed among all the patients by gender from 1998 to 2020. ResultsUnder NHI system, the number of patients with endodontic diseases increased from 1,985,413 in 1998 to the highest peak of 2,131,242 in 2004, and then decreased gradually to 1,803,645 in 2020. The total decreased number of patients was 181,768 from 1998 to 2020 with a total decrease rate of 9.16%. The dental use rate for endodontic diseases fluctuated slightly and decreased gradually from 9.09% in 1998 to 7.65% in 2020 with a total decrease rate of 15.88%. The total medical expenses for endodontic diseases fluctuated slightly and increased gradually from 4257.54 million NHI points in 1998–6569.98 million NHI points in 2020 with a total increase rate of 54.31%. All parameters of female patients were higher than those of male patients. ConclusionEndodontic diseases are still the main oral diseases. Therefore, the endodontology in Taiwan should develop not only the treatment technology for endodontic diseases, but also the prevention technology and methods for endodontic diseases.

Medical expenditure and its inequity for people with disabilities: Evidence from the CHARLS 2018 data.

IntroductionDisabilities may raise heavy medical expenses and rich-poor inequalities. However, data is lacking for the Chinese older populations. This study aimed to measure socioeconomic inequalities in medical expenses amongst the Chinese adult 45 years or older, and explored the main determinants among different disability categories.MethodData from the 2018 China Health and Retirement Longitudinal Study (CHARLS) were used. Disabilities were divided into five categories: physical disabilities, intellectual disability, vision problems, hearing problems, and multiple disabilities. The two-part model was employed to identify the factors that are associated with medical expenditures. Socioeconomic inequalities were measured by the concentration index (CI), and the horizontal inequity index (HI) which adjusts for health needs. Decomposition analysis was further applied to evaluate the contribution of each determinant.ResultsTwo thousand four hundred nineteen people were included in this study. The CIs and HIs of the expenditure were both positive. Amongst the varied types of medical expenses, the highest CIs were found for self-treatment expenses (0.0262). Amongst the five categories of disabilities, the group with vision problem disability reported the highest CIs and HIs for outpatient expenses (CI = 0.0843, HI = 0.0751), self-treatment expenses (CI = 0.0958, HI = 0.1119), and total expenses (CI = 0.0622, HI = 0.0541). The group of intellectual disability reported the highest CI and HI (CI = 0.0707, HI = 0.0625). The decomposition analysis showed that income (80.32%), education (25.14%) and living in the rural areas (13.96%) were the main determinants of medical expenses for HI amongst all types of disabilities.ConclusionFor five types of disabilities, our data shows that medical expenses concentrated in the richer groups in China. Income, education, and rural areas factors were the main contributors to the economic-related inequalities. Health policies to improve the affordability of medical care are needed to decrease inequity of medical expenditures for people with disabilities.

КЛЮЧОВІ ДЕТЕРМІНАНТИ СТАНУ РИНКУ ДЕРЖАВНОГО БОРГУ УКРАЇНИ В ДОВОЄННИЙ ПЕРІОД

Balance on the public debt market is a guarantee of the stability of public finances. The state of public debt and the country's debt security depend on the efficiency of the public debt market of any country. When determining the key determinants of the debt market state, indicators that take into account the macroeconomic conditions of the borrowing country should be taken into account. Therefore, the article focuses on relative indicators. In addition, it is worth taking into account not only the indicators contained in domestic regulations, but also international recommendations. Usually, international standards characterizing debt security are quite high. Compliance with such indicators is primarily important for countries with emerging markets, to which Ukraine belongs. And for highly developed countries, the key is compliance with solvency, not indicators and norms related to the size of the debt and its components. The key determinants of the Ukraine's public debt market state in the pre-war period were the definition and assessment of the following indicators: the ratio of state and guaranteed state debt to gross domestic product, the share of debt in foreign currency, the share of guaranteed debt, the share of external debt, the ratio of gross external debt to GDP and the ratio of official international reserves to external debt, an indicator of the ratio of debt repayment expenditures in relation to general budget expenditures, as well as the ratio of debt service expenditures in budget expenditures. All the analyzed indicators illustrate a permanent excess of the permissible norms, which are substantiated by scientists and recommended by international financial institutions. The high debt burden on the budget and the economy as a whole, caused by the State debt accumulated over the years, is extremely negative. The high level of expenses for maintenance and debt payment makes it necessary to reduce the total expenses of the state, which affects social or other components, or forces to expand fiscal sources and increase fiscal pressure.

Effect of Ultrasound-Guided Transversus Abdominis Plane Block Combined with Patient-Controlled Intravenous Analgesia on Postoperative Analgesia After Laparoscopic Cholecystectomy: a Double-Blind, Randomized Controlled Trial

PurposeTo compare the effect of ultrasound-guided transversus abdominis plane block (TAPB) combined with patient-controlled intravenous analgesia (PCIA) and PCIA alone on analgesia after laparoscopic cholecystectomy (LC). MethodsIn this double-blind, randomized controlled trial, 160 patients undergoing LC were randomized into the TAPB group (n = 80) and PCIA group (n = 80). Bilateral ultrasound-guided TAPB was performed with 20 mL 0.5% ropivacaine and the PCIA pump was given after LC in the TAPB group. The PCIA group received the PCIA pump alone as a control group. The primary outcome was postoperative pain, assessed by the visual analog scale (VAS). ResultsVAS pain (including abdominal wall pain or visceral pain) scores at rest and coughing were significantly lower in the TAPB group at 1, 4, 12, 24, 36, and 48 h after LC (P < 0.05). Postoperative additional analgesic needs, analgesic pump compressions, and PCIA analgesic dosages, and total morphine equivalents were significantly reduced in the TAPB group, and postoperative hospital stay, total hospitalization expenses, expenses within 24 h or 48 h (from analgesia and adverse reactions), and patient satisfaction were significantly higher in the TAPB group than the PCIA group (all P < 0.05). No significant between-group differences were observed in operation time, intraoperative blood loss, unplugging the analgesic pump due to adverse reactions, first exhaust time, and postoperative adverse events between the two groups. ConclusionsUltrasound-guided TAPB combined with PCIA was an effective and safe perioperative analgesic technique for patients undergoing LC compared to PCIA only.

Development and assessment of an onshore wind and concentrated solar based power, heat, cooling and hydrogen energy system for remote communities

Both solar and wind are considered leading renewables, and coupling them uniquely for solving the energy solutions in the remote communities is strongly needed to meet the demands of electricity, heat, cooling and hydrogen, which is the main goal of this study. In this regard, the present paper investigates a newly designed stand-alone onshore wind and concentrated solar-based hydrogen energy system where an anion exchange membrane electrolyzer, proton exchange membrane fuel cell, a heat pump, and absorption refrigeration chiller are considered as the other system components. The proposed system is then analyzed from the energy and exergy points of view of thermodynamics. Each hour in a typical meteorological year is considered in a time-dependent analysis to evaluate the feasibility as well as to better understand the phenomena and the effects of the varying parameters on the system performance. To perform a realistic analysis, the actual meteorological data and commercially available products' data are used based on the availability. The main contributions of this study to the state of the art of the current literature may be listed as the system originality, system integration for multigeneration, and time-dependent system analysis and performance assessment with the selected hourly parameters. A unique case study is performed for an indigenous community where a community load is generated for each hour by considering the meteorological characteristic of Cochrane, Ontario. The system capacities are designed according to the community in the case study where a 23 MWp wind farm, 3.17 MWp PT-CSP, 14.3 MW PEM fuel cell, and 19 MW AEM electrolyzer are required to fully meet the commodity requirements. The present wind and solar-based system brings synergetic advantages, such as lowering the energy storage capacity needed and providing a more synchronized operation. The overall integrated system's energy and exergy efficiencies are calculated as 20% and 19.5%, respectively. The cost assessment shows that the total operational expenses of the proposed integrated system result in $3.7 M each year while the total capital cost is $95 M. The hydrogen's unit cost is calculated as $4.38/kg, and the levelized cost of electricity is found to be $0.141/kWh. Finally, the synergetic advantages and disadvantages of using a wind and solar-based hydrogen energy system are discussed from the energetic, exergetic and economic perspectives.

Consumer Preferences for the Products of Minor Millets in Tumakuru District of Karnataka, India

The study was carried out in Tumakuru District of Karnataka, India during 2021-2022 to examine the consumer preferences for the products of Minor millets. Sample consumers were categorized into urban and rural consumer and data was enumerated from a total sample of 40 consumers comprising of 20 urban and 20 rural consumers. Finger millet was the most consumed among the urban consumers with 3.5 kg per month followed by foxtail millet 2.5 kg per month and little millet 2.0 kg per month, while the urban consumers were equally consuming other millets. The monthly household food expenditure among urban consumers, expenses made on groceries (38.03 percent), vegetables (13.79 percent) and millets (13.65 percent). The total food expenses made by urban consumers were Rs. 5404 of which 13.65 percent was made on millets which amounted to Rs. 745. Rural consumers were Rs. 3906 which was less than urban consumers (Rs.5404). For each respondent, part-worth were estimated using OLS regression analysis, rural consumers also found price to be the most significant attributes accounting 40.74 percent of relative importance, gaining awareness among consumers in consumption of millets for nutritional value and health benefits is improving progressively.

Health care costs and lost productivity costs related to excess weight in Belgium

BackgroundThis study aimed to estimate annual health care and lost productivity costs associated with excess weight among the adult population in Belgium, using national health data.MethodsHealth care costs and costs of absenteeism were estimated using data from the Belgian national health interview survey (BHIS) 2013 linked with individual health insurance data (2013–2017). Average yearly health care costs and costs of absenteeism were assessed by body mass index (BMI) categories – i.e., underweight (BMI < 18.5 kg/m2), normal weight (18.5 ≤ BMI < 25 kg/m2), overweight (25 ≤ BMI < 30 kg/m2) and obesity (BMI ≥ 30 kg/m2). Health care costs were also analysed by type of cost (i.e. ambulatory, hospital, reimbursed medication). The cost attributable to excess weight and the contribution of various other chronic conditions to the incremental cost of excess weight were estimated using the method of recycled prediction (a.k.a. standardisation).ResultsAccording to BHIS 2013, 34.7% and 13.9% of the Belgian adult population were respectively affected by overweight or obesity. They were mostly concentrated in the age-group 35–65 years and had significantly more chronic conditions compared to the normal weight population. Average total healthcare expenses for people with overweight and obesity were significantly higher than those observed in the normal weight population.The adjusted incremental annual health care cost of excess weight in Belgium was estimated at €3,329,206,657 (€651 [95% CI: €144-€1,084] and €1,015 [95% CI: €343–€1,697] per capita for individuals with overweight and obesity respectively). The comorbidities identified to be the main drivers for these incremental health care costs were hypertension, high cholesterol, serious gloom and depression. Mean annual incremental cost of absenteeism for overweight accounted for €242 per capita but was not statistically significant, people with obesity showed a significantly higher cost (p < 0.001) compared to the normal weight population: €2,015 [95% CI: €179–€4,336] per capita. The annual total incremental costs due to absenteeism of the population affected by overweight and obesity was estimated at €1,209,552,137. Arthritis, including rheumatoid arthritis and osteoarthritis, was the most important driver of the incremental cost of absenteeism in individuals with overweight and obesity, followed by hypertension and low back pain.ConclusionsThe mean annual incremental cost of excess weight in Belgium is of concern and stresses the need for policy actions aiming to reduce excess body weight. This study can be used as a baseline to evaluate the potential savings and health benefits of obesity prevention interventions.

Impact of COVID-19 Pandemic on Expenses of Medical Students Applying to Otolaryngology Residency Programs.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has led to many changes in the residency application process. The purpose of this study was to determine the impact of these changes on the cost of applying to otolaryngology residency programs. Materials and Methods: A retrospective, cross-sectional analysis was conducted using the Texas Seeking Transparency in Application to Residency (Texas STAR) Dashboard database to determine the differences in residency application costs from 2019 to 2022. Applicant information and cost data including application fees, interview expenses, away rotation expenses, total expenses, and geographic regions were collected. Median expenses and interquartile ranges were reported for each year and geographic region. Non-parametric comparisons were conducted.Results: Data from 499 otolaryngology applicants were collected from the Texas STAR database. The total expenses, interview expenses, and away rotation expenses of applicants from 2019 to 2022 were significantly decreased (p < 0.001) in all regions of the United States with the greatest decrease between 2020 and 2021. Application fees (p = 0.005) were not significantly different among regions of the United States throughout the time period studied.Conclusion: The COVID-19 pandemic significantly decreased the total expenses of applying to otolaryngology residencies including away rotation and interview expenses.