The Recovery of Health Service Costs in Cases Involving Personal Injury Compensation (205KB)

A Consultation Document

Sunk costs, extensive R&D subsidies and permanent inducement effects

We study whether there is scope for using subsidies to smooth out barriers to R&D performance and expand the share of R&D firms in Spain. We consider a dynamic model with sunk entry costs in which firms’ optimal participation strategy is defined in terms of two subsidy thresholds that characterise entry and continuation. We compute the subsidy thresholds from the estimates of a dynamic panel data type-2 tobit model for an unbalanced panel of about 2,000 Spanish manufacturing firms. The results suggest that “extensive” subsidies are a feasible and efficient tool for expanding the share of R&D firms.

Design of Novel Frequency Generation Circuit with Application to Ultra-Wideband Distributed Oscillators

Given the urgence of a new paradigm in wireless digital trasmission which should allow for higher bit rate, lower latency and tigher delay constaints, it has been proposed to investigate the fundamental building blocks that at the circuital/device level, will boost the change towards a more efficient network architecture, with high capacity, higher bandwidth and a more satisfactory end user experience. At the core of each transciever, there are inherently analog devices capable of providing the carrier signal, the oscillators. It is strongly believed that many limitations in today's communication protocols, could be relieved by permitting high carrier frequency radio transmission, and having some degree of reconfigurability. This led us to studying distributed oscillator architectures which work in the microwave range and possess wideband tuning capability. As microvave oscillators are essentially nonlinear devices, a full nonlinear analyis, synthesis, and optimization had to be considered for their implementation. Consequently, all the most used nonlinear numerical techniques in commercial EDA software had been reviewed. An application of all the aforementioned techniques has been shown, considering a systems of three coupled oscillator ("triple push" oscillator) in which the stability of the various oscillating modes has been studied. Provided that a certain phase distribution is maintained among the oscillating elements, this topology permits a rise in the output power of the third harmonic; nevertheless due to circuit simmetry, "unwanted" oscillating modes coexist with the intenteded one. Starting with the necessary background on distributed amplification and distributed oscillator theory, the design of a four stage reverse mode distributed voltage controlled oscillator (DVCO) using lumped elments has been presented. All the design steps have been reported and for the first time a method for an optimized design with reduced variations in the output power has been presented. Ongoing work is devoted to model a wideband DVCO and to implement a frequency divider.

The Costs of Caring for People with Dementia and Related Cognitive Impairments

The National Council on Ageing and Older People has undertaken a programme of research into dementia in Ireland. An Action Plan for Dementia provided a framework for the provision and planning of services for people with dementia in Ireland The Costs of Caring for People with Dementia and Related Cognitive Impairments is a complementary report to the Action Plan but with a more quantitative focus. The role of carers is one that is often taken for granted and is seen by many as a free resource. Dr Oâ?TShea explores what caring for a person with dementia entails in terms of the carers time, finances and stress. Evaluating the cost of caring for a person with dementia is the main focus of this study Download the Report here

Family Well-Being and Family Policy - A Review of Research on Benefits and Costs

This report is published under the Springboard Initiative. It is designed to assist in the process of mapping out the complex issues and data requirements which arise in developing policies for families and in finding actions which are known to promote family well-being Download the Report here

New-Generation Multifocal Intraocular Lens for Pediatric Cataract.

Background/Aims: To evaluate multifocal intraocular lens (MIOL) implantation in children. Methods: This is a retrospective study evaluating refractive, visual and safety results of MIOL in pediatric cataract surgery. Average follow-up was 25.73 ± 10.5 months. Surgery included 12 o'clock clear corneal incision, anterior capsulorhexis, lens material aspiration and MIOL implantation (SN6AD3; Alcon). Results: We included 34 cataract eyes of 26 pediatric patients aged 2-15 years, of which 14 (54%) were unilateral. Best near visual acuity (BNVA) and best distance visual acuity (BDVA) improved significantly in 100% of eyes (p = 0.0001). BDVA was above 0.8 in 31.25% (5/16) of bilateral cases. Significant stereopsis improvement was observed postoperatively in bilateral cases only (p = 0.01). Conclusion: MIOL implantation is a safe alternative to monofocal pseudophakia for pediatric cataract with a very low complication rate. Significant BNVA, BDVA and stereopsis improvement can be achieved, particularly in bilateral cases. Message: This study shows significant BDVA, BNVA and stereopsis improvement, especially in bilateral cases, after MIOL implantation for pediatric cataracts. © 2013 S. Karger AG, Basel.

Review of Measures to Reduce Costs in the Private Health Insurance Market 2013

Independent Report to the Minister for Health and Health Insurance Council Click here to download PDF 179KB  

Review of Measures to Reduce Costs in the Private Health Insurance Market 2013

This report was prepared independently by Mr McLoughlin with the insurers support, for consideration by the Minister for Health and the insurers.  All parties were very conscious of the importance of respecting competition law when dealing with issues such as prices and costs. The Phase 1 report contains 32 recommendations under 9 headings as follows: Most of the recommendations in the Phase 1 report could be implemented on an administrative basis, while a small number, if adopted, would require legislation. Some of the key recommendations to drive down costs are can be summarised as follows: Controlling costs in private health insurance Care settings and use of resources Age structure of the market Clinical audit and utilisation management Industry approach to private psychiatry Fraud, waste and abuse Chronic disease management Claims processing Admission and discharge procedures and processes. Most of the recommendations in the Phase 1 report could be implemented on an administrative basis, while a small number, if adopted, would require legislation.

Analyse de la prise en charge médicale et de l'impact économique des patients ayant présentés des coûts extrêmes dans un hôpital universitaire [Analysis of the medical management and the economic impact of patients who have represented extreme costs at a university hospital]

Les coûts de traitement de certains patients s'avèrent extrêmement élevés, et peuvent faire soupçonner une prise en charge médicale inadéquate. Comme I'évolution du remboursement des prestations hospitalières passe à des forfaits par pathologie, il est essentiel de vérifier ce point, d'essayer de déterminer si ce type de patients peut être identifié à leur admission, et de s'assurer que leur devenir soit acceptable. Pour les années 1995 et 1997. les coûts de traitement dépassant de 6 déviations standard le coût moyen de la catégorie diagnostique APDRG ont été identifiés, et les dossiers des 50 patients dont les coûts variables étaient les plus élevés ont été analysés. Le nombre total de patients dont I'hospitalisation a entraîné des coûts extrêmes a passé de 391 en 1995 à 328 patients en 1997 (-16%). En ce qui concerne les 50 patients ayant entraîné les prises en charge les plus chères de manière absolue, les longs séjours dans de multiples services sont fréquents, mais 90% des patients sont sortis de l'hôpital en vie, et près de la moitié directement à domicile. Ils présentaient une variabilité importante de diagnostics et d'interventions, mais pas d'évidence de prise en charge inadéquate. En conclusion, les patients qualifiés de cas extrêmes sur un plan économique, ne le sont pas sur un plan strictement médical, et leur devenir est bon. Face à la pression qu'exercera le passage à un mode de financement par pathologie, les hôpitaux doivent mettre au point un système de revue interne de I'adéquation des prestations fournies basées sur des caractéristiques cliniques, s'ils veulent garantir des soins de qualité. et identifier les éventuelles prestations sous-optimales qu'ils pourraient être amenés à délivrer. [Auteurs] Treatment costs for some patients are extremely high and might let think that medical care could have been inadequate. As hospital financing systems move towards reimbursement by diagnostic groups, it is essential to assess whether inadequate care is provided, to try to identify these patients upon admission, and make sure that their outcome is good. For the years 1995 and 1997, treatment costs exceeding by 6 standard deviations the average cost of their APDRG category were identified, and the charts of the 50 patients with the highest variable costs were analyzed. The total number of patients with such extreme costs diminished from 391 in 1995 to 328 in 1997 (-16%). For the 50 most expensive patients, long stays in several services were frequent, but 90% of these patients left the hospital alive, and about half directly to their home. They presented an important variation in diagnoses and operations, but no evidence for inadequate care. Thus, patients qualified as extreme from an economic perspective cannot be qualified as such from a medical perspective, and their outcome is good. To face the pressure linked with the change in financing system, hospitals must develop an internal review system for assessing the adequacy of care, based on clinical characteristics, if they want to guarantee good quality of care and identify potentially inadequate practice.

Review of Measures to Reduce Costs in the Private Health Insurance Market 2014

5.11.2014 This report was prepared independently by Mr McLoughlin with the support of the health insurers, and the Health Insurance Authority, for consideration by the Minister for Health and the insurers.  All parties were very conscious of the importance of respecting competition law when dealing with issues such as prices and costs. The work of the Group has been conducted in two phases, with the first phase report published on 26 December 2013. The Phase 1 report sets out the context, establishment, membership and terms of reference for both phases of the Groups work.  The report also outlines the legislative provisions for private health insurance in Ireland, the objectives of both phases of the review and the approach and methodology followed. Phase 2 of the process focused on the compilation and analysis by the Health Insurance Authority (HIA) of claims data to assess the cost drivers for health insurance, the effects of medical technology and innovations on costs, and claims processing issues.The report and submissions from relevant stakeholders which were examined and considered under the Phase 2 Review can be downloaded below. Download the Review of Measures to Reduce Costs in the Private Health Insurance Market 2014 -  Independent Report to the Minister for Health and Health Insurance Council here. Submissions received HSE Submission to Pat McLoughlin, Chair of Review Group IHAI submission 11 April 2014 IHCA submission to Chair 1 May 2014 Insurance Ireland submission Society of Actuaries in Ireland submission St. Patricks Mental Health Services submission April 2014 St John of Gods Submission        

Biology of the first generation of a laboratory colony of Nyssomyia intermedia (Lutz & Neiva, 1912) and Nyssomyia neivai (Pinto, 1926) (Diptera: Psychodidae)

The phlebotomine sand flies Nyssomyia intermedia (Lutz & Neiva, 1912) and Nyssomyia neivai (Pinto, 1926) are very close and may be involved in the transmission of Leishmania spp. Ross, 1903 in Brazil. The biology of the first laboratory-reared generations of these species, descended from insects captured in Além Paraíba (N. intermedia) and Corinto (N. neivai) in the Brazilian state of Minas Gerais, is described here. The captured females were fed on hamsters and maintained individually in rearing pots. Laboratory temperature and relative humidity were maintained at 25-26ºC and 80% respectively. The productivity of the first generation of N. intermedia was greater than that of N. neivai, and its development time clearly shorter, particularly for the second and third larval instars.

Prescriptions: Costs and charges in the UK and Republic of Ireland

This paper provides a brief overview of prescription costs and charges in Northern Ireland and compares this data with other jurisdictions in the UK and the Republic of Ireland. Read more here.

Unhealthy Consequences: Energy Costs and Child Health

Substantial and compelling medical and public health evidence indicated that non-medical factors, such as home energy costs, profoundly influence child health and well-being. Child Health Impact Assessment offered an evidence- and experience-based method through which to evaluate the implications of policy, regulations, and legislation for children's health and well-being. Our Child Health Impact Assessment of home energy costs revealed that unaffordable home energy has important and preventable adverse consequences for children's health. The available evidence showed that unaffordable home energy has preventable, potential consequences on the health and well-being of the more than 400,000 Massachusetts children living in low-income households. Low-income families are caught in the gap between rising energy prices and available energy assistance. Energy assistance falls far short of the need, especially when there is a spike in energy prices, such as following Hurricane Katrina in 2005. In addition to the exceedingly high housing costs in Massachusetts, our climate means low-income families spend more of their income on home energy (energy burden) to keep warm than families in other regions of the U.S.

New insights into the anti-inflammatory actions of aspirin- induction of nitric oxide through the generation of epi-lipoxins

Aspirin has always remained an enigmatic drug. Not only does it present with new benefits for treating an ever-expanding list of apparently unrelated diseases at an astounding rate but also because aspirin enhances our understanding of the nature of these diseases processe. Originally, the beneficial effects of aspirin were shown to stem from its inhibition of cyclooxygenase-derived prostaglandins, fatty acid metabolites that modulate host defense. However, in addition to inhibiting cyclooxygenase activity aspirin can also inhibit pro-inflammatory signaling pathways, gene expression and other factors distinct from eicosanoid biosynthesis that drive inflammation as well as enhance the synthesis of endogenous protective anti-inflammatory factors. Its true mechanism of action in anti-inflammation remains unclear. Here the data from a series of recent experiments proposing that one of aspirin's predominant roles in inflammation is the induction of nitric oxide, which potently inhibits leukocyte/endothelium interaction during acute inflammation, will be discussed. It will be argued that this nitric oxide-inducing effects are exclusive to aspirin due to its unique ability, among the family of traditional anti-inflammatory drugs, to acetylate the active site of inducible cyclooxygenase and generate a family of lipid mediators called the epi-lipoxins that are increasingly being shown to have profound roles in a range of host defense responses.