Estimates of hospital and physician costs of epilepsy in the United States for 1995 comparing the provider -based survey method and a patient -based medical charts and billing method

This investigation compares two different methodologies for calculating the national cost of epilepsy: provider-based survey method (PBSM) and the patient-based medical charts and billing method (PBMC&BM). The PBSM uses the National Hospital Discharge Survey (NHDS), the National Hospital Ambulatory Medical Care Survey (NHAMCS) and the National Ambulatory Medical Care Survey (NAMCS) as the sources of utilization. The PBMC&BM uses patient data, charts and billings, to determine utilization rates for specific components of hospital, physician and drug prescriptions. ^ The 1995 hospital and physician cost of epilepsy is estimated to be $722 million using the PBSM and $1,058 million using the PBMC&BM. The difference of $336 million results from $136 million difference in utilization and $200 million difference in unit cost. ^ Utilization. The utilization difference of $136 million is composed of an inpatient variation of $129 million, $100 million hospital and $29 million physician, and an ambulatory variation of $7 million. The $100 million hospital variance is attributed to inclusion of febrile seizures in the PBSM, $−79 million, and the exclusion of admissions attributed to epilepsy, $179 million. The former suggests that the diagnostic codes used in the NHDS may not properly match the current definition of epilepsy as used in the PBMC&BM. The latter suggests NHDS errors in the attribution of an admission to the principal diagnosis. ^ The $29 million variance in inpatient physician utilization is the result of different per-day-of-care physician visit rates, 1.3 for the PBMC&BM versus 1.0 for the PBSM. The absence of visit frequency measures in the NHDS affects the internal validity of the PBSM estimate and requires the investigator to make conservative assumptions. ^ The remaining ambulatory resource utilization variance is $7 million. Of this amount, $22 million is the result of an underestimate of ancillaries in the NHAMCS and NAMCS extrapolations using the patient visit weight. ^ Unit cost. The resource cost variation is $200 million, inpatient is $22 million and ambulatory is $178 million. The inpatient variation of $22 million is composed of $19 million in hospital per day rates, due to a higher cost per day in the PBMC&BM, and $3 million in physician visit rates, due to a higher cost per visit in the PBMC&BM. ^ The ambulatory cost variance is $178 million, composed of higher per-physician-visit costs of $97 million and higher per-ancillary costs of $81 million. Both are attributed to the PBMC&BM's precise identification of resource utilization that permits accurate valuation. ^ Conclusion. Both methods have specific limitations. The PBSM strengths are its sample designs that lead to nationally representative estimates and permit statistical point and confidence interval estimation for the nation for certain variables under investigation. However, the findings of this investigation suggest the internal validity of the estimates derived is questionable and important additional information required to precisely estimate the cost of an illness is absent. ^ The PBMC&BM is a superior method in identifying resources utilized in the physician encounter with the patient permitting more accurate valuation. However, the PBMC&BM does not have the statistical reliability of the PBSM; it relies on synthesized national prevalence estimates to extrapolate a national cost estimate. While precision is important, the ability to generalize to the nation may be limited due to the small number of patients that are followed. ^

The Impact of United States Sanctions on the Myanmar Garment Industry

The United States imposed trade sanctions against the military regime in Myanmar in July 2003. The import ban damaged the garment industry in particular. This industry exported nearly half of its products to the United States, and more than eighty percent of United States imports from Myanmar had been clothes. The garment industry was probably the main target of the sanctions. Nevertheless, the impact on the garment industry and its workers has not been accurately evaluated or closely examined. The purpose of this paper is to evaluate the impact of the sanctions and to further understand the present situation. This is done using several sources of information, including the author's field and questionnaire surveys. This paper also describes the process of selection and polarization underway in the garment industry, an industry that now has more severe competition fueled by the sanctions. Through such a process, the impact was inflicted disproportionately on small and medium-sized domestic firms and their workers.

Pakistani Migration to the United States:An Economic Perspective

The 9-11 attack on the US brought a set of changes in overseas migration from Pakistan. One such change is the sharp increase in remittances sent from the United States. The paper argues that the characteristics of remittances from the United States differ from those originating in the Middle East. Just as the overseas Pakistani communities are diversified, the nature and characteristics of remittances are heterogeneous, depending on where they come from and who sends them. While the importance of remittance flows from the United States is rising, not much academic attention has been paid to this issue because of a lack of data. To better understand the reasons behind the increase in US remittances, and in order to evaluate their sustainability, household surveys are necessary.

Distributed power generation in the United States

With electricity consumption increasing within the UnitedStates, new paradigms of delivering electricity are required in order to meet demand. One promising option is the increased use of distributedpowergeneration. Already a growing percentage of electricity generation, distributedgeneration locates the power plant physically close to the consumer, avoiding transmission and distribution losses as well as providing the possibility of combined heat and power. Despite the efficiency gains possible, regulators and utilities have been reluctant to implement distributedgeneration, creating numerous technical, regulatory, and business barriers. Certain governments, most notable California, are making concerted efforts to overcome these barriers in order to ensure distributedgeneration plays a part as the country meets demand while shifting to cleaner sources of energy.

A comparative analysis of road financing approaches in Europe and the United States

• The viability of the present system of road funding has in recent years been widely questioned, for it has proved insufficient to support spending programs at their current levels. • Some transfers from the general fund have been needed since 2008 to keep the HTF solvent. • Fuel taxes, the primary source for funding roads in the US, have not kept pace with inflation for years. • A wide variety of measures to increase revenue has been presented: raising fuel taxes, extending toll highways, implementing a VMT fee, etc.

Comparative analysis of road financing approaches in Europe and the United States

Road infrastructure has a remarkable economic and social impact on society. This is why road financing has always drawn the attention of policymakers, especially when resources available for government spending become scarce. Nations exhibit differing approaches to dealing with road transportation financing. In the United States, the current system of road funding has been called into question because some regard it as insufficient to meet the amounts now required for road expenditures. By contrast, in most European countries, road charges are very high, but these revenues are not allocated for the funding of roads. This paper analyzes the balance between charging for the use of and expenditure on the road sector in the United States and compares the American policy with those of several European countries (Germany, United Kingdom, France, Spain, and Switzerland). To that end, a methodology is defined to calculate the annual amount of fee charges levied on light and heavy vehicles in the selected countries in order to compare those charges with annual road expenditures. The results show that road charges in America are noticeably lower than those paid in Europe. Additionally, the research concludes that in Europe, road-generated revenues exceed road expenditures in all the countries studied, so road charges actually subsidize other policies. By contrast, in the United States, the public sector subsidizes the road system in order to maintain the current level of expenditure.

North American herpetology : or, A description of the reptiles inhabiting the United States / by John Edwards Holbrook.

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North American herpetology : or, A description of the reptiles inhabiting the United States / by John Edwards Holbrook.

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North American herpetology : or, A description of the reptiles inhabiting the United States / by John Edwards Holbrook.

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