The Congressional Budget Process and the Aggregate Level of Spending

This paper analyzes whether the Congressional budget process (instituted in 1974) leads to lower aggregate spending than does the piece-meal appropriations process that preceded it. Previous theoretical analysis, using spatial models of legislator preferences, is inconclusive. This paper uses a model of interest group lobbying, where a legislature determines spending on a national public good and on subsidies to subsets of the population that belong to nationwide sector-specific interest groups. In the appropriations process, the Appropriations Committee proposes a budget, maximizing the joint welfare of voters and the interest groups, that leads to overspending on subsidies. In the budget process, a Budget Committee proposes an aggregate level of spending (the budget resolution); the Appropriations Committee then proposes a budget. If the lobby groups are not subject to a binding resource constraint, the two institutional structures lead to identical outcomes. With such a constraint, however, there is a free rider problem among the groups in lobbying the Budget Committee, as each group only obtains a small fraction of the benefits from increasing the aggregate budget. If the number of groups is sufficiently large, each takes the budget resolution as given, and lobbies only the Appropriations Committee. The main results are that aggregate spending is lower, and social welfare higher, under the budget process; however, provision of the public good is suboptimal. The paper also presents two extensions: the first endogenizes the enforcement of the budget resolution by incorporating the relevant procedural rules into the model. The second analyzes statutory budget rules that limit spending levels, but can be revised by a simple majority vote. In each case,the free rider problem prevents the groups from securing the required changes to procedural and budget rules.

Eine Stimme aus dem Bureau : zur Vermehrung des Fondes der Arbeiter-Kranken-Institute der Wiener Cigarren-Fabriken

[Karl Felkl]

Erwiderung auf den Artikel: "Die Hebung des Obstbaues durch Provinzial-Institute"

F. Trelle

Ist der Obstbau durch Provinzial-Institute zu heben?

von B.L. Kühn

Die Hebung des Obstbaues durch Provinzial-Institute

von Otto Nattermüller

Na 1 Nachlass Max Horkheimer, 665 - "Research Project on Anti-Semitism" (p. IX 101-IX 112)

Institute of Social Research; "Research Project on Anti-Semitism. General Statement of Scope of Project, Fields to be investigated, First Assignements, Plan of Operation, Joint Conferences" (15.3.1943), a) Typoskript, 5 Blatt, b) Typoskript, 3 Blatt, c) Typoskript mit handschriftlichen Ergänzungen, 5 Blatt; Institute of Social Research: "Notes on Some Methodological Principles and Some Tentative Assumptions for the Work of the Anti-Semitism Project" (15.3.1943), Typoskript, 3 Blatt; "Project on Anti-Semitism. Excerpt from a letter of D.R. (American Jewish Committee), dated 3/31/43" (31.03.1943), Typoskript mit handschriftlichen Ergänzungen, 2 Blatt; Institute of Social Research: "Research Project on Anti-Semitism. General Statement of Scope of Project, Fields to be investigated, First Assignements etc. Supplement: Los Angeles Group" (26.4.1943), a) Typoskript mit handschriftlichen Ergänzungen, 13 Blatt, b) Typoskript, 13 Blatt, c) Typoskript, 8 Blatt; Heinz Langerhans: "Methods to Evaluate the Attitude of Different Sections of the German Population toward Institutionalized Antisemitism" (6.5.1943), Typoskript mit eigenhändiger Korrektur, 5 Blatt; "Discussion with Messrs. George Mintzer and Newman Levy on present day U.S.A. Antisemitism" (5.3.1943), a) Typoskript, 4 Blatt b) Typoskript mit handschriftlichen Korrekturen, 4 Blatt; Re.: Antisemitism Project. Statement of Expense 15.03.1943 - 15.06.1943, Preliminary Budget 15.06.1943 - 15.03.1944, Aufstellungen für das American Jewish Committee, 15.06.1943, 4 Blatt; Paul Massing: "Some Notes to Fineberg's 'Overcoming Antisemitism'" (16.06.1943), Typoskript, 4 Blatt; "Luncheon with Mr. Hexter. Present: Dr. Pollock, Weil, Gurland, Massing and Mr. Hexter. Purpose: Discussion of S.A. Fineberg's book 'Overcoming Antisemitism'" (17.06.1943), Typoskript, 2 Blatt; "Luncheon with Mr. R.C. Rothschild in the Yale Club", Über Antisemitismus in den USA, 28.6.1943, Typoskript mit handschriftlichen Korrekturen, 1 Blatt; Friedrich Pollock: Memoranden über Besprechungen mit R.C. Rothschild, betreffs Anti-Semitism-Project (September 1943): 1. "Remarks of Mr. Rothschild concerning our Psychological Study in a meeting between him, P. and L." (21.9.1943); 2. "Memorandum on work's progress of Anti-Semitism-Project" (15.09.1943), Typoskript, 1 Blatt; 3. "Meeting R.C. Rothschild and Pollock", (15.09.1943), Typoskript, 2 Blatt; 4. "Memorandum No. 1" (14.09.1943), Typoskript, 1 Blatt; "Memorandum re: Antisemitism Project" (29.10.1943), Typoskript mit handschriftlichen Ergänzungen, 2 Blatt;

Environmental sustainability and the human element: Decision making in National Cancer Institute-designated cancer centers and Practice Greenhealth subscribing institutions

Background. Various aspects of sustainability have taken root in the hospital environment; however, decisions to pursue sustainable practices within the framework of a master plan are not fully developed in National Cancer Institute (NCI) -designated cancer centers and subscribing institutions to the Practice Greenhealth (PGH) listserv.^ Methods. This cross sectional study was designed to identify the organizational characteristics each study group pursed to implement sustainability practices, describe the barriers they encountered and reasons behind their choices for undertaking certain sustainability practices. A web-based questionnaire was pilot tested, and then sent out to 64 NCI-designated cancer centers and 1638 subscribing institutions to the PGH listserv.^ Results. Complete responses were received from 39 NCI-designated cancer centers and 58 subscribing institutions to the PGH listserv. NCI-designated cancer centers reported greater progress in integrating sustainability criteria into design and construction projects than hospitals of institutions subscribing to the PHG listserv (p-value = <0.05). Statistically significant differences were also identified between these two study groups in undertaking work life options, conducting energy usage assessments, developing energy conservation and optimization plans, implementing solid waste and hazardous waste minimization programs, using energy efficient vehicles and reporting sustainability progress to external stakeholders. NCI-designated cancer centers were further along in implementing these programs (p-value = <0.05). In comparing the self-identified NCI-designated cancer centers to centers that indicated they were both and NCI and PGH, the later had made greater progress in using their collective buying power to pursue sustainable purchasing practices within the medical community (p-value = <0.05). In both study groups, recycling programs were well developed.^ Conclusions. Employee involvement was viewed as the most important reason for both study groups to pursue recycling initiatives and incorporated environmental criteria into purchasing decisions. A written sustainability commitment did not readily translate into a high percentage that had developed a sustainability master plan. Coordination of sustainability programs through a designated sustainability professional was not being undertaken by a large number of institutions within each study group. This may be due to the current economic downturn or management's attention to the emerging health care legislation being debated in congress. ^ Lifecycle assessments, an element of a carbon footprint, are seen as emerging areas of opportunity for health care institutions that can be used to evaluate the total lifecycle costs of products and services.^

Perinatal mortality and quality of care at the National Institute of Perinatology: A 3-year analysis

Quality of medical care has been indirectly assessed through the collection of negative outcomes. A preventable death is one that could have been avoided if optimum care had been offered. The general objective of the present project was to analyze the perinatal mortality at the National Institute of Perinatology (located in Mexico City) by social, biological and some available components of quality of care such as avoidability, provider responsibility, and structure and process deficiencies in the delivery of medical care. A Perinatal Mortality Committee data base was utilized. The study population consisted of all singleton perinatal deaths occurring between January 1, 1988 and June 30, 1991 (n = 522). A proportionate study was designed.^ The population studied mostly corresponded to married young adult mothers, who were residents of urban areas, with an educational level of junior high school or more, two to three pregnancies, and intermediate prenatal care. The mean gestational age at birth was 33.4 $\pm$ 3.9 completed weeks and the mean birthweight at birth was 1,791.9 $\pm$ 853.1 grams.^ Thirty-five percent of perinatal deaths were categorized as avoidable. Postnatal infection and premature rupture of membranes were the most frequent primary causes of avoidable perinatal death. The avoidable perinatal mortality rate was 8.7 per 1000 and significantly declined during the study period (p $<$.05). Preventable perinatal mortality aggregated data suggested that at least part of the mortality decline for amenable conditions was due to better medical care.^ Structure deficiencies were present in 35% of avoidable deaths and process deficiencies were present in 79%. Structure deficiencies remained constant over time. Process deficiencies consisted of diagnosis failures (45.8%) and treatment failures (87.3%), they also remained constant through the years. Party responsibility was as follows: Obstetric (35.4%), pediatric (41.4%), institutional (26.5%), and patient (6.6%). Obstetric responsibility significantly increased during the study period (p $<$.05). Pediatric responsibility declined only for newborns less than 1500 g (p $<$.05). Institutional responsibility remained constant.^ Process deficiencies increased the risk for an avoidable death eightfold (confidence interval 1.7-41.4, p $<$.01) and provider responsibility ninety-fivefold (confidence interval 14.8-612.1, p $<$.001), after adjustment for several confounding variables. Perinatal mortality due to prematurity, barotrauma and nosocomial infection, was highly preventable, but not that due to transpartum asphyxia. Once specific deficiencies in the quality of care have been identified, quality assurance actions should begin. ^

Cataract surgery in cancer patients and its impact on quality of life as measured by the National Eye Institute Visual Functioning Questionnaire - 25 (NEI-VFQ-25)

Purpose. The measurement of quality of life has become an important topic in healthcare and in the allocation of limited healthcare resources. Improving the quality of life (QOL) in cancer patients is paramount. Cataract removal and lens implantation appears to improve patient well-being of cancer patients, though a formal measurement has never been published in the US literature. In this current study, National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25), a validated vision quality of life metric, was used to study the change in vision-related quality of life in cancer patients who underwent cataract extraction with intraocular lens implantation. ^ Methods. Under an IRB approved protocol, cancer patients who underwent cataract surgery with intraocular lens implantation (by a single surgeon) from December 2008 to March 2011, and who had completed a pre- and postoperative NEI-VFQ-25 were retrospectively reviewed. Post-operative data was collected at their routine 4-6 week post-op visit. Patients' demographics, cancer history, their pre and postoperative ocular examinations, visual acuities, and NEI-VFQ-25 with twelve components were included in the evaluation. The responses were evaluated using the Student t test, Spearman correlation and Wilcoxon signed rank test. ^ Results. 63 cases of cataract surgery (from 54 patients) from the MD Anderson Cancer Center were included in the study. Cancer patients had a significant improvement in the visual acuity (P<0.0001) postoperatively, along with a significant increase in vision-related quality of life (P<0.0001). Patients also had a statistically significant improvement in ten of the twelve subcategories which are addressed in the NEI-VFQ-25. ^ Conclusions. In our study, cataract extraction and intraocular implantation showed a significant impact on the vision-related quality of life in cancer patients. Although this study includes a small sample size, it serves as a positive pilot study to evaluate and quantify the impact of a surgical intervention on QOL in cancer patients and may help to design a larger study to measure vision related QOL per dollar spent for health care cost in cancer patients.^