Effect of primary care availability and health insurance coverage on risk and cost of Preventable Hospitalizations in Harris County

Preventable Hospitalizations (PHs) are hospitalizations that can be avoided with appropriate and timely care in the ambulatory setting and hence are closely associated with primary care access in a community. Increased primary care availability and health insurance coverage may increase primary care access, and consequently may be significantly associated with risks and costs of PHs. Objective. To estimate the risk and cost of preventable hospitalizations (PHs); to determine the association of primary care availability and health insurance coverage with the risk and costs of PHs, first alone and then simultaneously; and finally, to estimate the impact of expansions in primary care availability and health insurance coverage on the burden of PHs among non-elderly adult residents of Harris County. Methods. The study population was residents of Harris County, age 18 to 64, who had at least one hospital discharge in a Texas hospital in 2008. The primary independent variables were availability of primary care physicians, availability of primary care safety net clinics and health insurance coverage. The primary dependent variables were PHs and associated hospitalization costs. The Texas Health Care Information Collection (THCIC) Inpatient Discharge data was used to obtain information on the number and costs of PHs in the study population. Risk of PHs in the study population, as well as average and total costs of PHs were calculated. Multivariable logistic regression models and two-step Heckman regression models with log-transformed costs were used to determine the association of primary care availability and health insurance coverage with the risk and costs of PHs respectively, while controlling for individual predisposing, enabling and need characteristics. Predicted PH risk and cost were used to calculate the predicted burden of PHs in the study population and the impact of expansions in primary care availability and health insurance coverage on the predicted burden. Results. In 2008, hospitalized non-elderly adults in Harris County had 11,313 PHs and a corresponding PH risk of 8.02%. Congestive heart failure was the most common PH. PHs imposed a total economic burden of $84 billion at an average of $7,449 per PH. Higher primary care safety net availability was significantly associated with the lower risk of PHs in the final risk model, but only in the uninsured. A unit increase in safety net availability led to a 23% decline in PH odds in the uninsured, compared to only a 4% decline in the insured. Higher primary care physician availability was associated with increased PH costs in the final cost model (β=0.0020; p<0.05). Lack of health insurance coverage increased the risk of PH, with the uninsured having 30% higher odds of PHs (OR=1.299; p<0.05), but reduced the cost of a PH by 7% (β=-0.0668; p<0.05). Expansions in primary care availability and health insurance coverage were associated with a reduction of about $1.6 million in PH burden at the highest level of expansion. Conclusions. Availability of primary care resources and health insurance coverage in hospitalized non-elderly adults in Harris County are significantly associated with the risk and costs of PHs. Expansions in these primary care access factors can be expected to produce significant reductions in the burden of PHs in Harris County.^

Economists' perceptions versus managers' decisions:an experiment in transaction cost analysis

Are the perceptions of professional economists on transaction costs consistent with make-or-buy decisions made within firms? The answer may have important implications for transaction cost research. Data on firms' outsourcing during the new product development process are taken from a largescale survey of UK, German and Irish manufacturing plants, and we test the consistency of these outsourcing decisions with the predictions derived from the transaction cost perceptions of a panel of economists. Little consistency is evident between actual outsourcing patterns and the predictions of the (Williamsonian) transactions cost model derived from the panel of economists. There is, however, evidence of a systematic pattern to the differences, suggesting that a competence or resource-based approach may be relevant to understanding firm outsourcing, and that firms are adopting a strategic approach to managing their external relationships. © Cambridge Political Economy Society 2005; all rights reserved.

CORD an object model supporting statistical summary information for management decision making

Information systems have developed to the stage that there is plenty of data available in most organisations but there are still major problems in turning that data into information for management decision making. This thesis argues that the link between decision support information and transaction processing data should be through a common object model which reflects the real world of the organisation and encompasses the artefacts of the information system. The CORD (Collections, Objects, Roles and Domains) model is developed which is richer in appropriate modelling abstractions than current Object Models. A flexible Object Prototyping tool based on a Semantic Data Storage Manager has been developed which enables a variety of models to be stored and experimented with. A statistical summary table model COST (Collections of Objects Statistical Table) has been developed within CORD and is shown to be adequate to meet the modelling needs of Decision Support and Executive Information Systems. The COST model is supported by a statistical table creator and editor COSTed which is also built on top of the Object Prototyper and uses the CORD model to manage its metadata.

The implications of cost behaviour for profit planning and control

The work described in the following pages was carried out at various sites in the Rod Division of the Delta Metal Company. Extensive variation in the level of activity in the industry during the years 1974 to I975 had led to certain inadequacies being observed 1n the traditional cost control procedure. In an attempt to remedy this situation it was suggested that a method be found of constructing a system to improve the flexibility of cost control procedures. The work involved an assimilation of the industrial and financial environment via pilot studies which would later prove invaluable to home in on the really interesting and important areas. Weaknesses in the current systems which came to light made the methodology of data collection and the improvement of cost control and profit planning procedures easier to adopt. Because of the requirements of the project to investigate the implications of Cost behaviour for profit planning and control, the next stage of the research work was to utilise the on-site experience to examine at a detailed level the nature of cost behaviour. The analysis of factory costs then showed that certain costs, which were the most significant exhibited a stable relationship with respect to some known variable, usually a specific measure of Output. These costs were then formulated in a cost model, to establish accurate standards in a complex industrial setting in order to provide a meaningful comparison against which to judge actual performance. The necessity of a cost model was •reinforced by the fact that the cost behaviour found to exist was, in the main, a step function, and this complex cost behaviour, the traditional cost and profit planning procedures could not possibly incorporate. Already implemented from this work is the establishment of the post of information officer to co-ordinate data collection and information provision.

On Reasonable Space and Time Cost Models for the λ-Calculus

Slot and van Emde Boas Invariance Thesis states that a time (respectively, space) cost model is reasonable for a computational model C if there are mutual simulations between Turing machines and C such that the overhead is polynomial in time (respectively, linear in space). The rationale is that under the Invariance Thesis, complexity classes such as LOGSPACE, P, PSPACE, become robust, i.e. machine independent. In this dissertation, we want to find out if it possible to define a reasonable space cost model for the lambda-calculus, the paradigmatic model for functional programming languages. We start by considering an unusual evaluation mechanism for the lambda-calculus, based on Girard's Geometry of Interaction, that was conjectured to be the key ingredient to obtain a space reasonable cost model. By a fine complexity analysis of this schema, based on new variants of non-idempotent intersection types, we disprove this conjecture. Then, we change the target of our analysis. We consider a variant over Krivine's abstract machine, a standard evaluation mechanism for the call-by-name lambda-calculus, optimized for space complexity, and implemented without any pointer. A fine analysis of the execution of (a refined version of) the encoding of Turing machines into the lambda-calculus allows us to conclude that the space consumed by this machine is indeed a reasonable space cost model. In particular, for the first time we are able to measure also sub-linear space complexities. Moreover, we transfer this result to the call-by-value case. Finally, we provide also an intersection type system that characterizes compositionally this new reasonable space measure. This is done through a minimal, yet non trivial, modification of the original de Carvalho type system.

New product warranty: A literature review

Warranty is an important element of marketing new products as better warranty signals higher product quality and provides greater assurance to customers. Servicing warranty involves additional costs to the manufacturer and this cost depends on product reliability and warranty terms. Product reliability is influenced by the decisions made during the design and manufacturing of the product. As such warranty is very important in the context of new products. Product warranty has received the attention of researchers from many different disciplines and the literature on warranties is vast. This paper carries out a review of the literature that has appeared in the last ten years. It highlights issues of interest to manufacturers in the context of managing new products from an overall business perspective. (C) 2002 Elsevier Science B.V. All rights reserved.

Activos fixos tangíveis numa empresa industrial do ramo automóvel transição para o SNC

Dissertação para a obtenção do grau de mestre em Contabilidade e Finanças Orientador: Mestre António Costa Reis

Adoção da NCRF 17 nas maiores empresas do sector agrícola em Portugal

Mestrado em Contabilidade

Propriedades de investimento : A problemática das diferentes bases de mensuração no contexto dos grupos económicos. O caso particular da Sonae Sierra

Mestrado em Contabilidade

Partial utility-driven scheduling for flexible SLA and pricing arbitration in clouds

Cloud SLAs compensate customers with credits when average availability drops below certain levels. This is too inflexible because consumers lose non-measurable amounts of performance being only compensated later, in next charging cycles. We propose to schedule virtual machines (VMs), driven by range-based non-linear reductions of utility, different for classes of users and across different ranges of resource allocations: partial utility. This customer-defined metric, allows providers transferring resources between VMs in meaningful and economically efficient ways. We define a comprehensive cost model incorporating partial utility given by clients to a certain level of degradation, when VMs are allocated in overcommitted environments (Public, Private, Community Clouds). CloudSim was extended to support our scheduling model. Several simulation scenarios with synthetic and real workloads are presented, using datacenters with different dimensions regarding the number of servers and computational capacity. We show the partial utility-driven driven scheduling allows more VMs to be allocated. It brings benefits to providers, regarding revenue and resource utilization, allowing for more revenue per resource allocated and scaling well with the size of datacenters when comparing with an utility-oblivious redistribution of resources. Regarding clients, their workloads’ execution time is also improved, by incorporating an SLA-based redistribution of their VM’s computational power.

Determinantes da escolha do modelo de revalorização na mensuração subsequente dos ativos fixos tangíveis em Portugal e no Brasil

Dissertação de Mestrado apresentada ao Instituto de Contabilidade e Administração do Porto para a obtenção do grau de Mestre em Contabilidade e Finanças, sob orientação da Professora Doutora Cláudia Maria Ferreira Pereira

The value relevance of investment property fair value

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Finance from the NOVA – School of Business and Economics

Financial reporting about investment properties: Evidence from Portuguese listed companies

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics

Kustannusmallien kehitys BCTMP- ja DIP-prosessien simulointimalleihin

Massa- ja paperiteollisuuden päästöt ovat vähentyneet huomattavasti viime vuosikymmenten aikana. Tiukentuvat viranomaismääräykset ja ympäristörajoitukset tulevat vaatimaan päästöjen määrien vähentämistä edelleen. Päästöttömät massanvalmistusprosessit olisivat ratkaisu näiden määräysten täyttämiseksi.Tämän työn tavoitteena on kehittää kustannusmallit Balas-ohjelmalla simuloitaville virtuaalisille BCTMP- sekä DIP-massanvalmistusprosesseille. Tarkoituksena on, että kustannusmallien avulla voidaan selvittää valmistusprosessien kustannusrakenteet ja erilaisten päästöttömyysratkaisujen vaikutus kustannusrakenteeseen. Lisäksi mallien avulla selvitetään päästöttömyysinvestointien kannattavuudet sekä mahdollisten päästöistä aiheutuvien kustannusten nousun vaikutus tehtyjen päästöttömyysinvestointien kannattavuuteen.Työn tuloksena syntyi Excel-taulukkolaskentaohjelmalla laadittu kustannuslaskentamalli, jonka avulla saadaan laskettua prosessien muuttuvat, kiinteät sekä pääomakustannukset toimintokohtaisesti. Teoriapohjana prosessien toimintojen määrittämisessä käytettiin toimintolaskentaa. Investointien kannattavuutta mallissa tarkastellaan nykyarvon, sisäisen korkokannan sekä takaisinmaksuajan menetelmällä. Kustannusten laskennassa käytettävät hintatiedot perustuvat laitetoimittajien tarjouksiin, massa-, paperi- ja kemikaalivalmistajien haastatteluihin sekä kirjallisuustutkimukseen.