Cost-containment in health care: The case of Spain from the eighties up to 1997

The purpose of this paper is to provide an overview of the evolutionof health care expenditure in Spain during the period 1980-1997, andhenceforth to comment on the cost containment measures put forwardto control its growth. The paper is divided into three separatesections. The first offers a brief description of the Spanish HealthCare System, with emphasis placed on the issue of expenditure controland health planning targets. The second part outlines a set of costcontainment measures that has accompanied the process of extendinguniversal health care coverage which occurred during the mentionedperiod and which has helped keep public expenditure under control.Finally, the third part describes some of the more recent proposalsfor reform of the Spanish Health Care Sector.

Cost efficiency in primary care contracting: A stochastic frontier cost function approach

The principal aim of this paper is to estimate a stochastic frontier costfunction and an inefficiency effects model in the analysis of the primaryhealth care services purchased by the public authority and supplied by 180providers in 1996 in Catalonia. The evidence from our sample does not supportthe premise that contracting out has helped improve purchasing costefficiency in primary care. Inefficient purchasing cost was observed in thecomponent of this purchasing cost explicitly included in the contract betweenpurchaser and provider. There are no observable incentives for thecontracted-out primary health care teams to minimise prescription costs, whichare not explicitly included in the present contracting system.

Does it cost to be virtuous? The macroeconomic effects of fiscal constraints

We study whether and how fiscal restrictions alter the business cycle features of macrovariables for a sample of 48 US states. We also examine the typical transmission properties of fiscal disturbances and the implied fiscal rules of states with different fiscal restrictions. Fiscal constraints are characterized with a number of indicators. There are similarities in second moments of macrovariables and in the transmission properties of fiscal shocks across states with different fiscal constraints. The cyclical response of expenditure differs in size and sometimes in sign, but heterogeneity within groups makes point estimates statistically insignificant. Creative budget accounting is responsible for the pattern. Implications for the design of fiscal rules and the reform of the Stability and Growth Pact are discussed.

An empirical evaluation of small area estimators

This paper investigates the comparative performance of five small areaestimators. We use Monte Carlo simulation in the context of boththeoretical and empirical populations. In addition to the direct andindirect estimators, we consider the optimal composite estimator withpopulation weights, and two composite estimators with estimatedweights: one that assumes homogeneity of within area variance andsquare bias, and another one that uses area specific estimates ofvariance and square bias. It is found that among the feasibleestimators, the best choice is the one that uses area specificestimates of variance and square bias.

Location of multiple server common service centers or public facilities for minimizing general congestion and travel cost functions

We propose a model and solution methods, for locating a fixed number ofmultiple-server, congestible common service centers or congestible publicfacilities. Locations are chosen so to minimize consumers congestion (orqueuing) and travel costs, considering that all the demand must be served.Customers choose the facilities to which they travel in order to receiveservice at minimum travel and congestion cost. As a proxy for thiscriterion, total travel and waiting costs are minimized. The travel costis a general function of the origin and destination of the demand, whilethe congestion cost is a general function of the number of customers inqueue at the facilities.

Fitness cost of resistance to Bacillus thuringiensis in velvetbean caterpillar Anticarsia gemmatalis Hübner (Lepidoptera, Noctuidae)

Selection pressure to obtain resistant genotypes can result in fitness cost. In this study, we report the effects of the selection pressure of a commercial formulation of Bacillus thuringiensis on biological aspects of a Dipel-resistant strain of velvetbean caterpillar, Anticarsia gemmatalis Hübner. Comparisons of Dipel-resistant and susceptible individuals revealed significant differences in pupal weight and larval development time. Both strains (Dipel-resistant and susceptible) were susceptible to Cry1Ac toxin expressed in foliar cotton tissues. Resistant and susceptible strains showed low survival rates of 22.5% and 51.2%, respectively, when fed with Greene diet containing Bt-cotton. Larvae bioassayed after three laboratory generations presented lower survival and less instar numbers than individuals maintained in the laboratory for more than 144 generations. Pupal weight was 9.4% lower and larval development time was 1.9 days longer in the resistant population than in the susceptible strain. Other parameters, such as duration of pupal stage, adult longevity, number of eggs per female, oviposition period, and egg fertility, remained unaffected.

Energetic cost of digging behavior in workers of the leaf-cutting ant Atta sexdens (Fabricius)

Energetic cost of digging behavior in workers of the leaf-cutting ant Atta sexdens (Fabricius). During nest excavation, leaf-cutting ant workers undergo reduction in their body reserve, particularly carbohydrates. In order to estimate the energetic cost of digging, groups of 30 workers of the leaf-cutting ant Atta sexdens were sealed in a hermetic chamber for 24, 48 and 72 hours, with and without soil for digging, and had the CO2 concentration measured using respirometric chambers as well as volume of soil excavated (g). As expected, the worker groups that carried out soil excavation expelled more carbon dioxide than the groups that did not excavate. Therefore, a worker with body mass of 9.65 ± 1.50 mg dug in average 0.85 ± 0.27 g of soil for 24 hours, consuming ca. 0.58 ± 0.23 J. In this study, we calculate that the energetic cost of excavation per worker per day in the experimental set-up was ca. 0.58 J.

Energetic and metabolic cost of growth in Gambian infants.

The aim of the study was to measure the energy used for growth of healthy fullterm and breast-fed Gambian infants. The weight gain (WG) of 14 infants (mean age +/- SEM 17 +/- 1 d, weight 3.581 +/- 0.105 kg) was measured over a 2-week period; the energy intake (EI) from breast milk was assessed for 24 h in the middle of the study period by weighing the infant before and after each breast-feed. On the same day, sleeping energy expenditure (SEE) and respiratory quotient (RQ) were measured for 30 min on five occasions through the 24-h period. EI averaged 502 +/- 25 kJ/kg.d, and SEE 230 +/- 6 kJ/kg.d; thus, an average of 272 kJ/kg.d were available for physical activity and the energy stored for growth. The total energy spent by infants while sleeping and for periods of physical activity was calculated to be 1.7 x SEE. The mean RQ measured on five occasions averaged 0.879 +/- 0.009. SEE was correlated with WG (r = 0.747, P less than 0.005), with a slope of the regression line of 5.5 kJ/g; this value can be considered as an estimate of the energy spent for new tissue synthesis in the resting infant. The efficiency of weight gain was lower in this study (67%) than in studies conducted on fast-growing preterm infants or children recovering from malnutrition.

The cost of inappropriateness of coagulation testing [I costi dell'inappropriatezza in coagulazione]

Background. Laboratory utilization has steadily increased with a corresponding increase in overall costs; several authors have attempted to measure the impact of inappropriateness on clinical outcomes but data are insufficient. The aim of the study is to assess the cost of inappropriateness of test-ordering behaviour for second-level coagulation tests (hemorrhagic diathesisand thrombophilia). Methods. We reviewed all second-level coagulation testrequests received by our department during a six months period. Clinicians must fill out a specific order form for these kind of tests, containing all informations deemed necessary for the laboratory specialist to evaluatethe appropriateness of the request. We identified all inappropriate requests and counted the numbers and types of all coagulation tests that were not performed during the period. An analysis of the laboratory activity costs was done in order to calculate the global costof each test in our department and to estimate the savings achieved. Results. On a total of 1664 second-level coagulationtest requests, we estimated 150 as completely inappropriate. We found an overall of 295 inappropriate testswhich were not performed. This resulted in an economic saving of 20.000 euro in 6 months. Conclusions. The analysis of cost of our intervention shows the urgent need for a definite and sustained reduction in inappropriate requests of second-level coagulation tests. Even though we estimated only the economic aspect of inappropriate testing, this is also associated with the overuse of diagnostic tests which entailsthe risk of generating erroneous results with potentialnegative consequences on patients' health.

Cost-effective utilization of a private facility to perform outpatient surgery in public hospital waiting list patients.

Background: Public hospitals' long waiting lists make outpatient surgery in private facilities very attractive provided a standardized protocol is applied. The aim of this study was to assess this kind of innovative collaboration in abdominal surgery from a clinical and economical perspective. Methods: All consecutive patients operated on in an outpatient basis in a private facility by a public hospital abdominal surgeon and an assistant over a 5-year period (2004-2009) were included. Clinical assessment was carried out from patients' charts and satisfaction questionnaire, and economic assessment from the comparison between the surgeons' charges paid by the private facility and the surgeons' hospital salaries during the days devoted to surgery at the private facility. Results: Over the 5 years, 602 operative procedures were carried out during 190 operative days. All patients could be discharged the same day and only 1% of minor complications occurred. The patients' satisfaction was 98%. The balance between the surgeons' charges paid by the private facility and their hospital salary costs was positive by 25.8% for the senior surgeon and 12.6% for the assistant or, on average, 21.9% for both. Conclusion: Collaboration between an overloaded university hospital surgery department and a private surgical facility was successful, effective, safe, and cost-effective. It could be extended to other surgical specialities. Copyright (C) 2011 S. Karger AG, Basel

Governor's Task Force on Efficiencies and Cost-Effectiveness in Iowa State Government,Final Report, December 1983

A special task force was formed and worked through its various committees to uncover and investigate possible areas for cutting costs and saving money in State Government operations. A total of 81 recommendations are made in this report, with potential savings of over $32 million during the next several years.

Detecció de matrícules amb sistemes de baix cost

En aquest projecte s'avaluen els mètodes utilitzats per els mecanismes de detecció de matrícules, i es proposarà un algorisme de detecció de matrícules dissenyat específicament per a sistemes de baix cost com ara els ordinadors actuals. Utilitzarem eines al nostre abast, com càmeres fotogràfiques domèstiques o de mòbil per analitzar el rendiment de l'algorisme

Constraint and cost of oxidative stress on reproduction: correlative evidence in laboratory mice and review of the literature.

ABSTRACT: BACKGROUND: One central concept in evolutionary ecology is that current and residual reproductive values are negatively linked by the so-called cost of reproduction. Previous studies examining the nature of this cost suggested a possible involvement of oxidative stress resulting from the imbalance between pro- and anti-oxidant processes. Still, data remain conflictory probably because, although oxidative damage increases during reproduction, high systemic levels of oxidative stress might also constrain parental investment in reproduction. Here, we investigated variation in oxidative balance (i.e. oxidative damage and antioxidant defences) over the course of reproduction by comparing female laboratory mice rearing or not pups. RESULTS: A significant increase in oxidative damage over time was only observed in females caring for offspring, whereas antioxidant defences increased over time regardless of reproductive status. Interestingly, oxidative damage measured prior to reproduction was negatively associated with litter size at birth (constraint), whereas damage measured after reproduction was positively related to litter size at weaning (cost). CONCLUSIONS: Globally, our correlative results and the review of literature describing the links between reproduction and oxidative stress underline the importance of timing/dynamics when studying and interpreting oxidative balance in relation to reproduction. Our study highlights the duality (constraint and cost) of oxidative stress in life-history trade-offs, thus supporting the theory that oxidative stress plays a key role in life-history evolution.