The impact of the financial costs of multiple sclerosis on quality of life

This study examined the financial costs of multiple sclerosis (MS) and the impact of financial strain on the subjective quality of life of people with MS and their families. Due to the lack of research in this area, a qualitative research design was employed. Interviews were conducted with 16 health professionals, 26 people with MS, and 11 family members of people who had MS. Adjusting to actual or threatened loss of income caused financial stress. These financial struggles led to a lower quality of life among respondents. Problem solving, coping, and positive reappraisal helped people to adjust to financial changes. Professionals focused on increased funding for services, whereas people with MS focused on improved income support. These findings highlight the need for professionals to consider the financial strain associated with this disease and the impact of this strain on the quality of life of individuals with MS and their families.

It's time to determine the cost of a healthy diet in Australia

Economic factors are important determinants of food security. In terms of food access, financial resources determine an individual’s ability to procure food; on the supply side, the cost of food is equally important. The interplay of these two factors, financial resources and cost, is perhaps the most immediate and important determinant of what people do (or do not) put into their shopping trolleys or purchase at the takeaway and ultimately eat – if you cannot afford it you cannot eat it even if you want to!

Providing health services to migrants and refugees settling in Victoria, Australia: an analysis of the complexity, cost and policy implications for public health

The aim of the research was to identify factors related to the increased costs of providing health services to clients from a non-English speaking background (NESB), using a cross-sectional analysis of the administrative records of clients using community health services in the Northern Metropolitan region of Melbourne for the 2001/2002 financial year. The higher cost of providing services to NESB clients was influenced by four factors: increased consultation time, group attendance to an appointment, increased interpreting costs and the type of service provider. Family members and multilingual staff play a significant role in providing informal interpreting services or low-cost support for NESB consultants, and these activities should receive appropriate support. Additional funding is needed to support interpreting requirements when dealing with the health needs of NESB clients.

The cost efficiency of New Zealand`s polytechnics

In New Zealand the most important institutions that are responsible for the delivery of vocational education and training programs are the government owned and operated tertiary education institutions known as polytechnics.' The New Zealand polytechnics deliver programs at the certificate, diploma and degree level. During the course of the 1990s, expansion of participation in vocational education and training was a major priority on the part of the New Zealand Government. In order to enable this to occur without placing too great a financial burden on the government and taxpayers, the polytechnics have become more dependent upon non-government sources of income (both student fees and other sources) and have been opened up to increasing levels of competition with the view that this will compel them to operate at higher levels of efficiency. As well, it is thought competition will make the polytechnics more responsive to the demands of students and industry. At the same time the polytechnics have been given more autonomy such that they have been able to move into the delivery of programs formerly denied to them. The purpose of this paper is to look at some aspects of the cost efficiency of the operation of polytechnics in New Zealand between the years 1995 and 2002. The efficient operation of the polytechnics in New Zealand is important because they need to operate at high levels of cost efficiency if they are to provide the greatest possible contribution to the development of New Zealand's skill and knowledge base. In particular one issue to consider was whether the creation of larger polytechnic institutions could achieve lower unit costs and, therefore educate a greater number of students without significantly increasing costs. In order to achieve these larger institutions, the various polytechnics have attempted to 1) expand enrolments by diversifying into the delivery of degree programs, 2) attract additional students from overseas and 3) arrange (or been forced by circumstances into) mergers in order to create larger scale institutions. In the next section, a background account of the nature of the vocational education sector and the role of the New Zealand polytechnic is given. Following this, a section containing an analysis of the cost efficiency of New Zealand's polytechnics is provided, and in the final section some conclusions are given.

Auditing construction costs during building design : a case study of cost planning in action

Building cost planning was originally developed in the framework of traditional procurement methods with conventional documentation, tendering and administration processes. With the advent of alternative forms of procurement with more fluid approaches to design stages and documentation, the need for sound cost planning does not appear to diminish. As a process established on solid theoretical foundations, cost planning should be robust enough to adapt and flourish in a variety of procurement environments. However, little documentation and analysis of transformed and adapted forms of cost planning appear to have been made. This case study of a design-construct company in Melbourne, Australia, presents and explores a contemporary form of building cost planning integrated into a design cost management approach adopted by a construction company experienced in alternative forms of procurement. The article traces this process on a design-construct project from inception to the end of the design development stage and tender. Whilst the fundamental framework of cost planning remains intact, the focus and detail in each of the stages are guided by the company's priority for greater financial control over the cost and value implications of design and other decisions. This recently established working model of design cost management in this company has been designed to deliver added value to the client through a better balance of time, cost and quality in each project.

Corporate governance, board responsibilities and financial performance : the National Bank of Australia

This paper examines board responsibilities and accountability by management and Board of Directors in relation to the National Australia Bank's (NABs) performance. The NAB, an international financial service provider within the top thirty most profitable banks in the world, is compared with the Australian major banks. The evidence suggests that NABs poor performance was consistent with a lack of accountability, poor corporate governance and board dysfunction associated with fraudulent currency trading and the subsequent AUD360 million foreign currency losses. The NAB's performance is investigated by utilising accounting-based measures of profitability and cost efficiency as proxies for performance. Following the foreign currency trading losses in 2004 the NAB under-performed the other major Australian banks in terms of profits, cost to income ratio and growth in assets. In terms of profitability and cost efficiency NAB had the lowest ROE and ROA with a 19.7% fall in net profit and the highest cost to income ratio of 5 7.4% of any of the five largest banks. This case study provides an Australian example of poor corporate governance and suggests that financial institutions and regulators can learn from the NAB's experience. Failure to have top-down accountability can have significant impact on over-all performance, profitability and reputation. In particular, it suggests that management and Boards need to review their risk management procedures and regulators need to be more pro-active in their prudential oversight of financial institutions.

Effects of financial disadvantage on use and non-use of after hours care in Australia

Policy addressing the provision of primary care after hours (AH) is currently in flux because of concerns about equity of access and cost. In this study we examine the effects of socioeconomic disadvantage on access to AH care and episodes of not seeking AH care when needed among users and non-users of AH care. The effects of health on these relationships were also explored. The total sample consisted of 5538 users of AH care and 891 non-users of AH care who were randomly selected for telephone interviews. Factors determining AH care included accessibility that is structural barriers to use of care such as distance and transport, as well as affordability and availability. Logistic regression was used to determine the impact of financial disadvantage on episodes of not seeking AH care. Barriers to use of AH care and household health were subsequently added to the models to assess their impact. The results suggested that there were inequities in access to AH care but these were a function of barriers to AH care use rather than financial disadvantage per se. Accessibility and availability were significant barriers to use of AH clinics among both user and non-user samples. Affordability was only a significant barrier among users of AH care. The study suggests that policy aimed at reducing these barriers may effectively address inequities in AH care but that to be optimally effective policy change would also need to be accompanied by changes in consumer awareness.

The effects of financial constraints on corporate policies in Australia

We jointly study the impact of financial constraints on Australian companies' investment decisions and demand for liquidity. By examining a large sample of Australian firms over the period 1990–2003, we find that financial constraints not only reduce the sensitivity of investment to the availability of internal funds, but also increase the responsiveness of cash holdings to internally generated cash flows. Further analysis shows that the impact of financial constraints varies across different cash flow states; that is, financial constraints have a small effect on corporate investment and cash policies when cash flows are positive. In contrast, the severity of constraints is high in negative cash flow years in which the cost disadvantage of external finance coincides with deteriorating operating performance.

The global financial crisis and the centro properties group earnings revision and refinancing announcements : an event study

This study analyses the impact of the global financial crisis using Centro Properties Group's earnings revision and refinancing announcements on December 17th 2007 as the event date to investigate the change in risk profile for A-REITs that were included in the S&P/ASX 300. The study finds that nine of the 25 A-REIT constituents on the S&P/ASX 300 recorded statistically significant negative abnormal returns on 17th December 2007 and that the systematic risk for many A-REITs moved significantly higher after this date. This increased systematic risk has major implications for the cost of capital to the sector.

Towards the development of a construction supply chain transaction cost economic model for strategic infrastructure procurement evaluation

Australia has adopted public-private partnership (PPP) as a major strategy for procuring infrastructure for decades. However, even though considered to be a mature and sophisticated market, several major
failures have occurred resulting in increasing financial burdens on taxpayers. Failures have typically been traced back to economic evaluation and, in particular, value-for-money across the supply chain
in the original proposal. However, the literature review identified that there was no economic model that evaluated holistically the transaction costs of PPPs across the supply chain. In this paper, theories of transaction cost economics and construction supply chain economics are critiqued and analysed in order to develop a strategic infrastructure procurement evaluation model. The model will offer decision makers with an insight into project life cycle economic outcomes needed to successfully deliver PPPs.

Life cycle cost analysis of silicon and organic building integrated photovoltaic systems (BiPV)

Despite the undisputed benefits associated with photovoltaic (PV) technology, the financial barrier acts as the major hurdle before it is seen as a commercial competitive form of renewable energy. Many studies have been performed outlining the life cycle energy benefits of PV technology. However, there has been limited number of studies dedicated to the life cycle cost impacts. The aim of this paper is to identify whether life cycle cost analysis is the best approach to determining the cost contributors or savings associated with this technology. This paper has been structured similarly to previous life cycle energy studies to consider the cost implications involved within each area of the products lifecycle. Amongst many new developments, traditional silicon based units have been challenged by the introduction of new organic systems; and recent studies highlight that these systems offer major cost reductions. Based on an analysis of current literature, this paper identifies that the recent growth and development of both organic and silicon based systems have had a considerable effect on the cost of PV cells. The competitive nature of the renewable energy market will also impact on a life cycle cost analysis; and any potential findings will valid for a limited timeframe.

Cost effectiveness of a general practice chronic disease management plan for coronary heart disease in Australia

Background. The cost effectiveness of a general practice-based program for managing coronary heart disease (CHD) patients in Australia remains uncertain. We have explored this through an economic model.

Methods. A secondary prevention program based on initial clinical assessment and 3 monthly review, optimising of pharmacotherapies and lifestyle modification, supported by a disease registry and financial incentives for quality of care and outcomes achieved was assessed in terms of incremental cost effectiveness ratio (ICER), in Australian dollars per disability adjusted life year (DALY) prevented.

Results. Based on 2006 estimates, 263 487 DALYs were attributable to CHD in Australia. The proposed program would add $115 650 000 to the annual national heath expenditure. Using an estimated 15% reduction in death and disability and a 40% estimated program uptake, the program’s ICER is $8081 per DALY prevented. With more conservative estimates of effectiveness and uptake, estimates of up to $38 316 per DALY are observed in sensitivity analysis.

Conclusions. Although innovation in CHD management promises improved future patient outcomes, many therapies and strategies proven to reduce morbidity and mortality are available today. A general practice-based program for the optimal application of current therapies is likely to be cost-effective and provide substantial and sustainable benefits to the Australian community.

What is known about this topic? Chronic disease management programs are known to provide gains with respect to reductions in death and disability among patients with coronary heart disease. The cost effectiveness of such programs in the Australian context is not known.

What does this paper add? This paper suggests that implementing a coronary heart disease program in Australia is highly cost-effective across a broad range of assumptions of uptake and effectiveness.

What are the implications for practitioners? These data provide the economic rationale for the implementation of a chronic disease management program with a disease registry and regular review in Australia.

A review of the cost estimation issues in the tender preparation process in construction industry

Cost estimation process is undertaken to predict the total cost of the project. Studies indicate that one of the construction company failures in contracting is because of the uncertain, incorrect, and unrealistic cost estimation. Cost estimation process are heavily influenced by the complexity of the project, scale and scope of construction, market conditions, method of construction, site constraints, client’s financial position, buildability and the location of the project. However, there are other combinations factors that have not been studied thus far. Hence, this paper focuses on the review of other researchers’ findings in relation to cost estimation issues in the construction industry. Among the findings, it has been revealed that the cost estimation issues are related to accuracy, human factors, practical knowledge and insufficient cost data/information. The aim of this paper is to investigate these factors and determining other potential factors that may influence cost estimation process in the construction industry.

The cost of healthcare for children with mental health difficulties

Objective: Childhood mental health difficulties affect one in every seven children in Australia, posing a potential financial burden to society. This paper reports on the early lifetime individual and population non-hospital healthcare costs to the Australian Federal Government for children experiencing mental health difficulties. It also reports on the use and cost of particular categories of service use, including the Medicare Benefits Schedule (MBS) mental health items introduced in 2006.