Attributable risk analysis reveals potential healthcare savings from increased consumption of dairy products.

With rising burdens of obesity and chronic disease, the role of diet as a modifiable risk factor is of increasing public health interest. There is a growing body of evidence that low consumption of dairy products is associated with elevated risk of chronic metabolic and cardiovascular disorders. Surveys also suggest that dairy product consumption falls well below recommended targets for much of the population in many countries, including the USA, UK, and Australia. We reviewed the scientific literature on the health effects of dairy product consumption (both positive and negative) and used the best available evidence to estimate the direct healthcare expenditure and burden of disease [disability-adjusted life years (DALY)] attributable to low consumption of dairy products in Australia. We implemented a novel technique for estimating population attributable risk developed for application in nutrition and other areas in which exposure to risk is a continuous variable. We found that in the 2010-2011 financial year, AUD$2.0 billion (USD$2.1 billion, €1.6 billion, or ∼1.7% of direct healthcare expenditure) and the loss of 75,012 DALY were attributable to low dairy product consumption. In sensitivity analyses, varying core assumptions yielded corresponding estimates of AUD$1.1-3.8 billion (0.9-3.3%) and 38,299-151,061 DALY lost. The estimated healthcare cost attributable to low dairy product consumption is comparable with total spending on public health in Australia (AUD$2.0 billion in 2009-2010). These findings justify the development and evaluation of cost-effective interventions that use dairy products as a vector for reducing the costs of diet-related disease.

Factors influencing retirement savings intentions in Botswana

 This study identified and tested some factors that affect retirement savings decisions in Botswana. Subjective norms, financial literacy and attitude were found to have positive effects on intentions to make additional voluntary contributions (AVC) to retirement savings. With these results, targeted intervention efforts will aid policy formulation designed to induce additional voluntary retirement savings.

Influence of body mass index on prescribing costs and potential cost savings of a weight management programme in primary care

Objectives Prescribed medications represent a high and increasing proportion of UK health care funds. Our aim was to quantify the influence of body mass index (BMI) on prescribing costs, and then the potential savings attached to implementing a weight management intervention.

Methods Paper and computer-based medical records were reviewed for all drug prescriptions over an 18-month period for 3400 randomly selected adult patients (18–75 years) stratified by BMI, from 23 primary care practices in seven UK regions. Drug costs from the British National Formulary at the time of the review were used. Multivariate regression analysis was applied to estimate the cost for all drugs and the ‘top ten’ drugs at each BMI point. This allowed the total and attributable prescribing costs to be estimated at any BMI. Weight loss outcomes achieved in a weight management programme (Counterweight) were used to model potential effects of weight change on drug costs. Anticipated savings were then compared with the cost programme delivery. Analysis was carried out on patients with follow-up data at 12 and 24 months as well as on an intention-to-treat basis. Outcomes from Counterweight were based on the observed lost to follow-up rate of 50%, and the assumption that those patients would continue a generally observed weight gain of 1 kg per year from baseline.

Results The minimum annual cost of all drug prescriptions at BMI 20 kg/m2 was £50.71 for men and £62.59 for women. Costs were greater by £5.27 (men) and £4.20 (women) for each unit increase in BMI, to a BMI of 25 (men £77.04, women £78.91), then by £7.78 and £5.53, respectively, to BMI 30 (men £115.93 women £111.23), then by £8.27 and £4.95 to BMI 40 (men £198.66, women £160.73). The relationship between increasing BMI and costs for the top ten drugs was more pronounced. Minimum costs were at a BMI of 20 (men £8.45, women £7.80), substantially greater at BMI 30 (men £23.98, women £16.72) and highest at BMI 40 (men £63.59, women £27.16). Attributable cost of overweight and obesity accounted for 23% of spending on all drugs with 16% attributable to obesity. The cost of the programme was estimated to be approximately £60 per patient entered. Modelling weight reductions achieved by the Counterweight weight management programme would potentially reduce prescribing costs by £6.35 (men) and £3.75 (women) or around 8% of programme costs at one year, and by £12.58 and £8.70, respectively, or 18% of programme costs after two years of intervention. Potential savings would be increased to around 22% of the cost of the programme at year one with full patient retention and follow-up.

Conclusion Drug prescriptions rise from a minimum at BMI of 20 kg/m2 and steeply above BMI 30 kg/m2. An effective weight management programme in primary care could potentially reduce prescription costs and lead to substantial cost avoidance, such that at least 8% of the programme delivery cost would be recouped from prescribing savings alone in the first year.

Why foreign savings fail to cause growth

Este artigo é uma formalização da crítica à estratégia do crescimento com poupança externa que um de seus autores vem sendo fazendo nos últimos anos. Apesar dos países de renda média serem pobres de capital, os déficits em conta corrente (poupança externa), financiado seja por empréstimos ou por investimentos externos diretos, não irá aumentar a taxa de acumulação de capital ou terá pouco impacto sobre ela, uma vez que os déficits de conta corrente estarão associados taxas de câmbio apreciadas, ordenados e salários aumentados artificialmente e altos níveis de consumo. Consequentemente, a taxa de substituição da poupança externa pela interna será relativamente alta, e o país será obrigado não a investir e crescer, mas a consumir. Apenas quando há grandes oportunidades de investimento, estimuladas por uma ampla diferença entre a taxa de lucro esperada e a taxa de juros de longo prazo, a propensão marginal ao consumo diminuirá suficientemente, a ponto de o lucro adicional originário do fluxo de capital estrangeiro ser usado para investimento, ao invés de para consumo. Neste caso especial, a taxa de substituição de poupança externa pela interna tenderá a ser menor e a poupança interna contribuirá positivamente para o crescimento

Essays in heterogeneous agent macroeconomics

This thesis is comprised of three chapters. The first article studies the determinants of the labor force participation of elderly American males and investigates the factors that may account for the changes in retirement between 1950 and 2000. We develop a life-cycle general equilibrium model with endogenous retirement that embeds Social Security legislation and Medicare. Individuals are ex ante heterogeneous with respect to their preferences for leisure and face uncertainty about labor productivity, health status and out-of-pocket medical expenses. The model is calibrated to the U.S. economy in 2000 and is able to reproduce very closely the retirement behavior of the American population. It reproduces the peaks in the distribution of Social Security applications at ages 62 and 65 and the observed facts that low earners and unhealthy individuals retire earlier. It also matches very closely the increase in retirement from 1950 to 2000. Changes in Social Security policy - which became much more generous - and the introduction of Medicare account for most of the expansion of retirement. In contrast, the isolated impact of the increase in longevity was a delaying of retirement. In the second article, I develop an overlapping generations model of criminal behavior, which extends prior research on crime by taking into account individuals' labor supply decisions and the stigma effect that affects convicted offenders, lowering their likelihood of employment. I use the model to guide a quantitative assessment of the determinants of crime and of a counterfactual experiment in which an income redistribution policy is thought as an alternative to greater law enforcement. The model economy considered in this paper is populated by heterogeneous agents who live for a realistic number of periods, have preferences over consumption and leisure, and differ in terms of their age, their skills as well as their employment shocks. In addition, savings may be precautionary and allow partial insurance against the labor income shocks. Because of the lack of full insurance, this model generates an endogenous distribution of wealth across consumers, enabling us to assess the welfare implications of the redistribution policy experiment. I calibrated the model using the US data for 1980 and then use the model to investigate the changes in criminality between 1980 and 1996. The main results that come out of this study are: 1) Law enforcement policy was the most important factor behind the fall in criminality in the period, while the increase in inequality was the most important single factor promoting crime; 2) Stigmatization is not a free-cost crime control policy; 3) Income redistribution can be a powerful alternative policy to fight crime. Finally, the third article studies the impact of HIV/AIDS on per capita income and education. It explores two channels from HIV/AIDS to income that have not been sufficiently stressed by the literature: the reduction of the incentives to study due to shorter expected longevity and the reduction of productivity of experienced workers. In the model individuals live for three periods, may get infected in the second period and with some probability die of Aids before reaching the third period of their life. Parents care for the welfare of the future generations so that they will maximize lifetime utility of their dynasty. The simulations predict that the most affected countries in Sub-Saharan Africa will be in the future, on average, thirty percent poorer than they would be without AIDS. Schooling will decline in some cases by forty percent. These figures are dramatically reduced with widespread medical treatment, as it increases the survival probability and productivity of infected individuals.

Essays in taxation and savings

Esta tese é composta por três artigos. Dois deles investigam assuntos afeitos a tributação e o terceiro é um artigo sobre o tema “poupança”'. Embora os objetos de análise sejam distintos, os três possuem como característica comum a aplicação de técnicas de econometria de dados em painel a bases de dados inéditas. Em dois dos artigos, utiliza-se estimação por GMM em modelos dinâmicos. Por sua vez, o artigo remanescente é uma aplicação de modelos de variável dependente latente. Abaixo, apresenta-se um breve resumo de cada artigo, começando pelos dois artigos de tributação, que dividem uma seção comum sobre o ICMS (o imposto estadual sobre valor adicionado) e terminando com o artigo sobre poupança. O primeiro artigo analisa a importância da fiscalização como instrumento para deter a evasão de tributos e aumentar a receita tributária, no caso de um imposto sobre valor adicionado, no contexto de um país em desenvolvimento. O estudo é realizado com dados do estado de São Paulo. Para tratar questões relativas a endogeneidade e inércia na série de receita tributária, empregam-se técnicas de painel dinâmico. Utiliza-se como variáveis de controle o nível do PIB regional e duas proxies para esforço fiscal: a quantidade e o valor das multas tributárias. Os resultados apontam impacto significativo do esforço fiscal nas receitas tributárias. O artigo evidencia, indiretamente, a forma como a evasão fiscal é afetada pela penalidade aplicada aos casos de sonegação. Suas conclusões também são relevantes no contexto das discussões sobre o federalismo fiscal brasileiro, especialmente no caso de uma reforma tributária potencial. O segundo artigo examina uma das principais tarefas das administrações tributárias: a escolha periódica de contribuintes para auditoria. A melhora na eficiência dos mecanismos de seleção de empresas tem o potencial de impactar positivamente a probabilidade de detecção de fraudes fiscais, provendo melhor alocação dos escassos recursos fiscais. Neste artigo, tentamos desenvolver este mecanismo calculando a probabilidade de sonegação associada a cada contribuinte. Isto é feito, no universo restrito de empresas auditadas, por meio da combinação “ótima” de diversos indicadores fiscais existentes e de informações dos resultados dos procedimentos de auditoria, em modelos de variável dependente latente. Após calculados os coeficientes, a probabilidade de sonegação é calculada para todo o universo de contribuintes. O método foi empregado em um painel com micro-dados de empresas sujeitas ao recolhimento de ICMS no âmbito da Delegacia Tributária de Guarulhos, no estado de São Paulo. O terceiro artigo analisa as baixas taxas de poupança dos países latino-americanos nas últimas décadas. Utilizando técnicas de dados em painel, identificam-se os determinantes da taxa de poupança. Em seguida, faz-se uma análise contrafactual usando a China, que tem apresentado altas taxas de poupança no mesmo período, como parâmetro. Atenção especial é dispensada ao Brasil, que tem ficado muito atrás dos seus pares no grupo dos BRICs neste quesito. O artigo contribui para a literatura existente em vários sentidos: emprega duas amplas bases de dados para analisar a influência de uma grande variedade de determinantes da taxa de poupança, incluindo variáveis demográficas e de previdência social; confirma resultados previamente encontrados na literatura, com a robustez conferida por bases de dados mais ricas; para alguns países latino-americanos, revela que as suas taxas de poupança tenderiam a aumentar se eles tivessem um comportamento mais semelhante ao da China em outras áreas, mas o incremento não seria tão dramático.

Consumo, poupança precaucionária, lei crédito consignado e impacto sobre alocação de ativos e distribuição de consumo

Esta tese é composta por três ensaios a respeito de consumo e poupança. O primeiro traz uma aplicação de poupança precaucionária para os Estados Unidos. O segundo e terceiro artigos fazem aplicações para o Brasil usando a POF 1995-96, 2002-03 e 2008- 09 para o segundo, e as duas últimas pesquisas para o terceiro. O segundo artigo avalia convergência nos padrões de gastos das famílias em duas cestas distintas de bens: uma de alimentos e outra para produtos eletroeletrônicos, enquanto o terceiro artigo explora a Lei de Crédito Consignado e seu impacto na forma de alocação da poupança precaucionária das famílias.

Neutralizing the tendency to the overvaluation of the exchange rate or assuming a foreign constraint and asking for foreign savings

The objectives of these notes are two. The first objective is to analyze whether the strategy of growth with absorption of foreign savings leads to a trajectory of the economy that is sustainable in the long run. The second one is to evaluate the possibility of success of a policy of administered devaluation of the exchange rate in Brazil.

A QUANTITATIVE APPROACH TO SUBSIDIZE THE PRECAUTIONARY MANAGEMENT of THE SMALL-SCALE FISHERIES IN ITAIPU RESERVOIR, BRAZIL

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Savings, investment and growth in the global age: analytical and policy issues

Includes bibliography

Savings in Latin America after the mid 1990s: determinants, constraints and policies

Includes bibliography