Cost Sharing

We introduce a combinatorial variant of the cost sharing problem: several services can be provided to each player and each player values every combination of services differently. A publicly known cost function specifies the cost of providing every possible combination of services. A combinatorial cost sharing mechanism is a protocol that decides which services each player gets and at what price. We look for dominant strategy mechanisms that are (economically) efficient and cover the cost, ideally without overcharging (i.e., budget balanced). Note that unlike the standard cost sharing setting, combinatorial cost sharing is a multi-parameter domain. This makes designing dominant strategy mechanisms with good guarantees a challenging task. We present the Potential Mechanism -a combination of the VCG mechanism and a wellknown tool from the theory of cooperative games: Hart and Mas-Colell's potential function. The potential mechanism is a dominant strategy mechanism that always covers the incurred cost. When the cost function is subadditive the same mechanism is also approximately efficient. Our main technical contribution shows that when the cost function is submodular the potential mechanism is approximately budget balanced in three settings: supermodular valuations, symmetric cost function and general symmetric valuations, and two players with general valuations.

We introduce a combinatorial variant of the cost sharing problem: several services can be provided to each player and each player values every combination of services differently. A publicly known cost function specifies the cost of providing every possible combination of services. A combinatorial cost sharing mechanism is a protocol that decides which services each player gets and at what price. We look for dominant strategy mechanisms that are (economically) efficient and cover the cost, ideally without overcharging (i.e., budget balanced). Note that unlike the standard cost sharing setting, combinatorial cost sharing is a multi-parameter domain. This makes designing dominant strategy mechanisms with good guarantees a challenging task.

Las enfermedades cronico-degenerativas ponen en riesgo la vida de quien la sufre y alteran las actividades diarias de los otros integrantes de la familia, ya que tanto el enfermo como sus familiares viven cambios en diferentes aspectos. Por ello, el objetivo de esta investigacion fue describir los cambios que enfermo y familia presentan en la cotidianidad familiar. Se trabajo con 112 participantes que tuvieran o fueran enfermos cronico-degenerativos, a quienes se aplicaron instrumentos para evaluar su vida familiar. En los resultados se identificaron cambios en la alimentacion, horarios de comidas, gasto, actividades compartidas, comunicacion y forma de afrontar la enfermedad y sus consecuencias, tanto en el paciente como en la familia. Las autoras analizan las consecuencias de la enfermedad en las funciones organicas, sociales y emocionales en la vida del enfermo y su familia.

The study reconfirmed prevalence of reverse tenancy in dryland agriculture in Southern India in recent years (2009-10 and 2011-12) as was in the mid-seventies. Household level panel data collected from six villages by ICRISAT under its Village Level Studies (VLS) and Village Dynamics Studies (VDS) programme were analysed. Area under tenancy has increased in recent years, mostly in the form of sharecropping. Panel Data Probit analysis revealed that likelihood of a household to be a tenant is positively linked with bullock ownership and large farm size while age and education of the household head, and dependence on non-farm income had a negative association. Determinants of extent of tenancy (rented in area) were measured through Panel Data Feasible Generalised Least Square (FGLS) regression analysis. Results indicated that an additional bullock increased rented-in area by 0.22 ha. On the other hand, large farmers had 0.47 ha more area under rented-in compared to other tenants. There...

This paper presents a theoretical framework to describe the physicians' behavior under the fee-for-service scheme in Japan by explicitly incorporating the behavioral difference between self-employed and hospital-employed physicians into the model. One crucial assumption is found in the difference in the employment structure related to their income. The results show that self-employed physicians always provide unnecessary non-labor medical treatments, while

A universal prescription drug coverage policy remains an unfinished business of Canadian healthcare system with over sixty year long historical roots. Since national medicare doesn't provide prescription drugs outside of hospitals, provinces and territories have independently developed public drug insurance programs (primarily for seniors and the poorest on social assistance) under various eligibility and patient cost-sharing arrangements. The absence of universal public coverage inevitably created a large role for private financing of prescription drugs by means of a variety of costly private insurance plans and out-of-pocket payments that many Canadians cannot afford. This situation has by now driven the system to a crisis point where the phenomenon of fast-rising costs of medically necessary drugs has added further adverse effects on public health, in terms of reduced equity of access and lost socio-economic wellbeing. It costs the health system billions of dollars downstream by requiring additional visits to physicians and resulting hospitalizations as patient health conditions deteriorate due to cost-related non-adherence to prescriptions. In the past a number of attempts towards making a national pharmacare failed and the status quo with a confusing patchwork prevailed. Of late, the federal government has taken a sincere initiative to implement a universal drug coverage plan inclusive of some measure of usercharge. This study evaluates the likely impact of different types of patient charges in a public system of prescription drug coverage for Canada. Employing qualitative and quantitative methods of analysis, it examines both primary and secondary data to evaluate the three policy options considered in this study. Taking all aspects into account, reasonable policy recommendations are made to make an affordable and efficient prescription drug coverage for all Canadians with the aim of reducing cost-related non-adherence to prescriptions, providing improved access to medications and, in the end, to achieve better health outcomes.

A universal prescription drug coverage policy remains an unfinished business of Canadian healthcare system with over sixty year long historical roots. Since national medicare doesn't provide prescription drugs outside of hospitals, provinces and territories have independently developed public drug insurance programs (primarily for seniors and the poorest on social assistance) under various eligibility and patient cost-sharing arrangements. The absence of universal public coverage inevitably created a large role for private financing of prescription drugs by means of a variety of costly private insurance plans and out-of-pocket payments that many Canadians cannot afford. This situation has by now driven the system to a crisis point where the phenomenon of fast-rising costs of medically necessary drugs has added further adverse effects on public health, in terms of reduced equity of access and lost socio-economic wellbeing. It costs the health system billions of dollars downstream by requiring additional visits to physicians and resulting hospitalizations as patient health conditions deteriorate due to cost-related non-adherence to prescriptions. In the past a number of attempts towards making a national pharmacare failed and the status quo with a confusing patchwork prevailed. Of late, the federal government has taken a sincere initiative to implement a universal drug coverage plan inclusive of some measure of usercharge. This study evaluates the likely impact of different types of patient charges in a public system of prescription drug coverage for Canada. Employing qualitative and quantitative methods of analysis, it examines both primary and secondary data to evaluate the three policy options considered in this study. Taking all aspects into account, reasonable policy recommendations are made to make an affordable and efficient prescription drug coverage for all Canadians with the aim of reducing cost-related non-adherence to prescriptions, providing improved access to medications and, in the end, to achieve better health outcomes.

Purpose - The objective of the study is to investigate the relationship between the credit information sharing and the funding cost of banks of the top ten “AA rating” commercial banks of Pakistan as the Commercial banks also play a significant role in the economy of every country. Design/Methodology - In this study, panel data were analyzed from 2011 to 2017. We selected the top ten “AA rating” banks from Pakistan credit rating agency (PACRA) website, and data related to another related variables are obtained from financial statements of the respective banks. Generalized Method of Moments (GMM) statistical technique was employed to measure the relationship among related variables. Findings - The result of the study shows that there is a negative and significant relationship between credit information sharing, operation efficiency, and funding cost. On the other side, profitability has a positive and significant relationship with the funding cost of the bank. Practical Implications ...

Impermeable pavements and roofs in urban areas convert most rainfall to runoff, which is commonly discharged to local sewers pipes and finally to the nearby streams and rivers. In case of heavy rain, the peak flow of runoff usually exceeds the carrying capacity of the local sewer pipes, leading to urban flooding. Traditional facilities, such as green roofs, permeable pavements, soakaways, rainwater tanks, rain barrels, and others reduce the runoff volume in case of a small rain but fail in case of a heavy rain. Here we propose a novel rainwater buffer tank to detain runoff from the nearby sealed surfaces in case of heavy rain and then to discharge rainwater from an orifice at the tank's bottom. We found that considering a 100 m 2 rooftop with 0.80 runoff coefficient and a 10cm rainfall depth for an hour, a cubic tank with internal edge side of a square of 2 m attenuates the peak flow about 45%. To reduce a desirable peak flow, the outlet orifice of the buffer tank must be optimized according to site-specific conditions. The orifice can be set at an elevation from the tank's bottom to create a dead storage for harvesting rainwater.

Background: One of the ways for cost-sharing in health system that has been taken into consideration in recent years in some developed countries is paying deductibles. In case of using deductibles, the insured people more carefully and accurately will use health care services, and potentially many unnecessary costs will be avoided. Methods: To investigate the evidence of deductibles in health systems across the world, a literature review was conducted by searching the materials published in databases including ISI web of science, PubMed, Scopus and also Google scholar search engine from 2000 to 2017. Besides the related websites including WHO and the World Bank were searched. Inclusion criteria were studies carried out only in health insurance, English language, and the year of the study. Results: The most important positive impacts of deductibles were decrease in utilization of different services, high profitability for the young and healthy people, lower health benefit claims by t...

Türkiye'de Maden Geri Kazanımının Optimize Edilmesi: Yığın Boyutlandırma Teknolojisinin Gelişmiş Uygulaması

Michael Guan, Landsky İş Geliştirme Müdürü

En İyi Maden Eleme Çözümleri Sağlayıcısı ve Asya'nın En Büyük Maden Eleme Elekleri Üreticisi ve  "Doğrusal Titreşimli Elek", "Çok Katlı Yüksek Frekanslı İnce Elek (Derrick'in Yığın Boyutlandırıcısına Benzer)" vb. dahil olmak üzere Çin Standartlarının Düzenleyici Sorumlu Kuruluşu; Çin Metalurji İnce Eleme Makineleri Mühendisliği Teknoloji Araştırma Merkezi tarafından hazırlanan “Major Mineral Sectors in Turkey” bilgi notudur.

To examine the effect of providing the Medicare & You handbook on consumers' attitudes and behavior regarding health plan decision making. A national sample of 3,738 Medicare beneficiaries who were surveyed in late 1999 and early 2000 was employed. Data were collected using a mail survey with telephone follow-up; the response rate was 76 percent. Medicare beneficiaries were randomly assigned to a control group that received no Medicare-related in formation as part of the study, or to a treatment group that received a copy of the 2000 version of the Medicare & You handbook as part of a national mailing. Half of the treat men t group (the "re-mail" group) received a second copy of the handbook along wit h their mail survey instrument. The control and treatment groups did not differ regarding their level of satisfaction with or confidence in their current choice of health plan according to predicted mean values. Treatment group beneficiaries had a significantly higher pro...

Background: We present data on quality of care (QC) improvement in 35 of 45 National Quality Forum metrics reported annually by 52 primary care practices recognized as patient-centered medical homes (PCMHs) that participated in the Maryland Multi-Payor Program from 2011 to 2013. Methods: We assigned QC metrics to (1) chronic, (2) preventive, and (3) mental health care domains. The study used a panel data design with no control group. Using longitudinal fixed-effects regressions, we modeled QC and case mix severity in a PCMH. Results: Overall, 35 of 45 quality metrics reported by 52 PCMHs demonstrated improvement over 3 years, and case mix severity did not affect the achievement of quality improvement. From 2011 to 2012, QC increased by 0.14 (P < .01) for chronic, 0.15 (P < .01) for preventive, and 0.34 (P < .01) for mental health care domains; from 2012 to 2013 these domains increased by 0.03 (P ‫؍‬ .06), 0.04 (P ‫؍‬ .05), and 0.07 (P ‫؍‬ .12), respectively. In univariate analyses, lower National Commission on Quality Assurance PCMH level was associated with higher QC for the mental health care domain, whereas case mix severity did not correlate with QC. In multivariate analyses, higher QC correlated with larger practices, greater proportion of older patients, and readmission visits. Rural practices had higher proportions of Medicaid patients, lower QC, and higher QC improvement in interaction analyses with time. Conclusions: The gains in QC in the chronic disease domain, the preventive care domain, and, most significantly, the mental health care domain were observed over time regardless of patient case mix severity. QC improvement was generally not modified by practice characteristics, except for rurality.

Nursing service is an important component of healthcare service, thus improving nursing service quality is a primary objective of the healthcare system as well as a major responsibility of nurse administrators. The purposes of this research were to study nurses and patients expectation of nursing service quality, to study nurses and patients perception of performance of nursing service quality performed by nurses and to compare nursing service quality as perceived by nurses and patients. Subjects included 162 nurses and 383 patients from 11 inpatient wards/units in Indira Gandhi Memorial hospital, Maldives. The instruments used in the study were SERVQUAL scale for nurses and patients. Content validity index of SERVQUAL scales were 0.82 for nurses and 0.82 for patients. Reliability of the scales was verified

Nursing service is an important component of healthcare service, thus improving nursing service quality is a primary objective of the healthcare system as well as a major responsibility of nurse administrators. The purposes of this research were to study nurses and patients expectation of nursing service quality, to study nurses and patients perception of performance of nursing service quality performed by nurses and to compare nursing service quality as perceived by nurses and patients. Subjects included 162 nurses and 383 patients from 11 inpatient wards/units in Indira Gandhi Memorial hospital, Maldives. The instruments used in the study were SERVQUAL scale for nurses and patients. Content validity index of SERVQUAL scales were 0.82 for nurses and 0.82 for patients. Reliability of the scales was verified

This paper studies the relationship between medical compliance and health outcomeshospitalization and mortality rates -using a large panel of patients residing in a local health authority in Italy. These data allow us to follow individual patients through all their accesses to public health care services until they either die or leave the local health authority. We adopt a disease specific approach, concentrating on hypertensive patients treated with ACE-inhibitors. Our results show that medical compliance has a clear effect on both hospitalization and mortality rates: health outcomes clearly improve when patients become more compliant to drug therapy. At the same time, we are able to infer valuable information on the role that drug co-payment can have on compliance, and as a consequence on health outcomes, by exploiting the presence of two natural experiments during the period of analysis. Our results show that drug co-payment has a strong effect on compliance, and that this effect is immediate. * Financial support from Pfizer is gratefully acknowledged. We thank Alessandro Chinellato and Giulio Nati for many valuable comments and ideas regarding the clinical aspects of the research involved. We also thank Anne

ABSTRACTChanges in cost sharing and remuneration system in the Netherlands in 2006 led to clear changes in financial incentives faced by both consumers and general practitioner (GPs). For privately insured consumers, cost sharing was abolished, whereas those socially insured never faced cost sharing. The separate remuneration systems for socially insured consumers (capitation) and privately insured consumers (fee‐for‐service) changed to a combined system of capitation and fee‐for‐service for both groups. Our first hypothesis was that privately insured consumers had a higher increase in patient‐initiated GP contact rates compared with socially insured consumers. Our second hypothesis was that socially insured consumers had a higher increase in physician‐initiated contact rates. Data were used from electronic medical records from 32 GP‐practices and 35 336 consumers in 2005–2007. A difference‐in‐differences approach was applied to study the effect of changes in cost sharing and remune...

Berman and Schnitger (10) gave a randomized reduction from approximating MAX- SNP problems (24) within constant factors arbitrarily close to 1 to approximating clique within a factor of n (for some ). This reduction was further studied by Blum (11), who gave it the name randomized graph products. We show that this reduction can be made deterministic (derandomized), using random

The overall goal of this project was to develop a high-temperature melt properties database with sufficient reliability to allow mathematical modeling of glass melting and forming processes for improved product quality, improved efficiency and lessened environmental impact. It was initiated by the United States glass industry through the NSF Industry/University Center for Glass Research (CGR) at Alfred University . Because of their important commercial value, six different types/families of glass were studied: container, float, fiberglass (E-and wool-types), low-expansion borosilicate, and color TV panel glasses. CGR member companies supplied production-quality glass from all six families upon which we measured, as a function of temperature in the molten state, density, surface tension, viscosity, electrical resistivity, infrared transmittance (to determine high temperature radiative conductivity), non-Newtonian flow behavior, and oxygen partial pressure. With CGR cost sharing, we also studied gas solubility and diffusivity in each of these glasses. Because knowledge of the compositional dependencies of melt viscosity and electrical resistivity are extremely important for glass melting furnace design and operation, these properties were studied more fully. Composition variations were statistically designed for all six types/families of glass. About 140 different glasses were then melted on a laboratory scale and their viscosity and electrical resistivity measured as a function of temperature.

In this paper we study an expression for all additive, symmetric and efficient solutions, i.e., the set of axioms that traditionally are used to characterize the Shapley value except for the dummy axiom. Also, we obtain an expression for this kind of solutions by including the self duality axiom. These expressions allow us to give an alternative formula for the

This study suggests that during the period 1995-2005, the average cost of Cypriot commercial banks is close to that of Greek banks, but higher than the average cost of UK commercial banks, albeit the latter difference declines over time. In addition, Cypriot (and UK) commercial banks operate in positive economies of scale, so that they can improve their competitiveness by

The Farmácia Popular Program (FPP) launched a subsidy system in Brazil, but in coexistence with the ongoing regular governmental access to medicines (Unified Health System (SUS) dispensings) mechanisms, causing overlaps in terms of financing and target population. This characteristic is quite different from most countries with medicines cost-sharing schemes. This paper aims to analyse the FPP under a health systems perspective considering the different health system levels. We analysed the findings from the study 'Impact of consecutive subsidies policies on access to and use of medicines in Brazil -ISAUM-Br', designed with the objective of describing and evaluating the impact of the government medicines subsidy policies implemented between 2004 and 2011. Patient share of copayment increased with the implementation of the intervention, which decreased the reference price and decreased with SNP (Saúde Não Tem Preço; zero copayment for patients). There was an increased number of FPP dispensations over time, but SUS dispensings remained the most important source for medicines, especially for hypertension and diabetes. FPP allowed the establishment of a well-designed pharmaceutical information system in the country. Despite the improvement on control mechanism, fraud remained a problem. There were important effects on the pharmaceutical market and sales of generic medicines. FPP has proven to be a very important policy for promoting access to medicines for hypertension and diabetes in Brazil. Examining this policy with a health system perspective has allowed us to highlight many of its important consequences, including for the first time a broad and consistent information system on access to medicines in the country.

Las enfermedades cronico-degenerativas ponen en riesgo la vida de quien la sufre y alteran las actividades diarias de los otros integrantes de la familia, ya que tanto el enfermo como sus familiares viven cambios en diferentes aspectos. Por ello, el objetivo de esta investigacion fue describir los cambios que enfermo y familia presentan en la cotidianidad familiar. Se trabajo con 112 participantes que tuvieran o fueran enfermos cronico-degenerativos, a quienes se aplicaron instrumentos para evaluar su vida familiar. En los resultados se identificaron cambios en la alimentacion, horarios de comidas, gasto, actividades compartidas, comunicacion y forma de afrontar la enfermedad y sus consecuencias, tanto en el paciente como en la familia. Las autoras analizan las consecuencias de la enfermedad en las funciones organicas, sociales y emocionales en la vida del enfermo y su familia.

Una enfermedad crónica-degenerativa inevitablemente amenaza las funciones del individuo y de su familia. Ésta tiene que reorganizarse, replantear expectativas y adecuar metas y objetivos ante la situación, tomar decisiones importantes y en ocasiones difíciles; es decir, vive un proceso donde surge como estrategia de afrontamiento la esperanza de una opción a la enfermedad y miedo a lo que ocurra generando expectativas mayores a la realidad hasta que se ajustan o no a las condiciones reales tanto institucionales, económicas y sociales. Palabras Clave: Familia, enfermedad, enfermedad crónica-degenerativa, ajuste. A chronic-degenerative disease inevitably threatens the functions of the individual and his family. The family has to take very important decisions and sometimes they are difficult. The members of the family will have to reorganize, rethink their expectations, goals and objectives to be adapted to the situation. This means they have to live a process which it emerges as a coping strategy based on hope. Family is fear of what happen and that' why they have to generate higher expectations to reality, until they conform or not to the actual institutional, economic and social conditions.

Many family farming and indigenous communities depend on grazing livestock activities and are particularly prone to drought risks. Vulnerability to drought limits the ability of these households to exit poverty and in many cases leads to environmental degradation. It is well known that uninsured exposure exacerbates income inequality in farming systems and eventually results in welfare losses for rural families. The advantages of farmers who have access to financial tools have been widely acknowledged. However, high administrative costs of traditional insurance hinder small farmers&#39; access to risk manage-ment tools. One of the main problems in insurance design relates to the lack of quality data to estimate the risk premium. In rural areas where there are no historical records of farm production data on adverse events such as drought. New technologies such as remote sensing help to overcome this problem and generate information from these areas that otherwise would be impossible...

Medicaid is the largest funding source of health services for the poorest people in the United States. Medicaid enrollees have greater health care, needs, and higher health risks than other individuals in the country and, experience disproportionately low rates of preventive care. Without, Medicaid coverage, poor uninsured adults may not be vaccinated or would, rely on publicly-funded programs that provide vaccinations. We examined each programs' policies related to benefit coverage and, copayments for adult enrollees. Our study was completed between October 2011 and September 2012 using a document review and a survey of Medicaid administrators that assessed coverage and cost-sharing policy for fee-for-service programs. Results were compared to a similar review, conducted in 2003. Over the past 10 years, Medicaid programs have typically maintained or expanded vaccination coverage benefits for adults and nearly half have explicitly prohibited copayments. The 17 programs that cover all recommended vaccines while prohibiting, copayments demonstrate a commitment to providing increased access to vaccinations for adult enrollees. When developing responses to fiscal and political challenges, the programs that do not cover all ACIP recommended adult vaccines or those that permit copayments for vaccinations, should consider all strategies to increase vaccinations and reduce costs to enrollees.

Immunizations represent both basic clinical care as well as an essential public health activity with population-wide health implications, and for a number of reasons, the focus on national immunization policy has intensified in recent years. Insurers and employee health plans may cover immunization services as a matter of benefit design choice. Federal and state insurance laws also may mandate coverage of one or more classes of immunization services. For approximately 100 million persons who are members of state-regulated health insurance plans, state law plays a primary role in determining coverage. Thus the extent of state immunization health insurance mandates is essential in examining the overall adequacy of health insurance financing for immunization services. This analysis is part of a comprehensive study of the "epidemiology" of U.S. immunization law. It provides a detailed assessment of state immunization statutes in force as of winter 2003. Its principal findings are as follows: • Thirty three (33) states have an immunization mandate, while approximately a third have no mandate. Of the 18 without any mandate, 9 have either a universal or a "select universal" purchase and distribution system for children. Among the 33 states with some level of mandate, 7 also have universal systems. • Among the 33 states that maintain some form of immunization mandate, there is considerable variation in the extent and depth of the mandate. Researchers evaluated state immunization laws against a typology that focuses on the elements of a comprehensive insurance immunization statute: (a) whether coverage is mandated; (b) the age ranges and categories of enrollees covered by the mandate; (c) the standard of coverage used to define the mandate; (d) prohibitions against deductibles and copayments or other cost sharing; and (e) regulation of networks and payment rates.) Results were as follows: O Mandated coverage versus mandated offer: With one exception, states mandate coverage rather than an offer of coverage. O Mandate extended to enrollee sub-groups: With limited exceptions (3 states) for women, mandates never cover adult enrollees, even adults with ACIP-recognized health risks. Among children, states vary considerably with respect to the age groups covered. O Standard of coverage: The ACIP is the standard of coverage for children in 6 states. The remaining states vary extensively in how they express their coverage standards. O Cost-sharing: States vary considerably in the cost sharing protections they include in their mandates. Thirteen (13) states prohibit both copayments and deductibles. O Network and pricing: No state insurance mandates address either network or pricing. • When the elements of a comprehensive statute are assembled into various, increasingly relaxed "composite" statutes, a modest number of states can be considered to have a comprehensive law. No state statute meets the most rigorous definition of "comprehensive;" that is, no state mandates coverage of all children up to 18, sets coverage at the ACIP standard, and prohibits both copayments and deductibles. Under the most relaxed definition of a comprehensive statute (either covering to age 18 or cutting off at an earlier age, using either ACIP or an alternative standard, and either prohibiting or permitting copayments) the number of states that meet this lesser comprehensiveness test rises to 15. Only by completely eliminating both protections against deductibles as well as any standard of coverage (either ACIP or otherwise) does the number of states with qualifying statutes increase appreciably. We recommend several steps, including the development of model state insurance immunization legislative language, as well as further research aimed at achieving a greater understanding of state law in this area.

Prior research indicates that cost-sharing and lack of insurance coverage reduce preventive services use among low-income persons. State Medicaid policy may affect the uptake of recommended adult vaccinations. We examined the impact of three aspects of Medicaid benefit design (coverage for vaccines, prohibiting cost-sharing, and copayment amounts) on vaccine uptake in the fee-for-service Medicaid population 19-64 years old. We combined previously published reports to obtain state Medicaid policy information from 2003 and 2012. Data on influenza vaccination uptake were taken from the Behavioral Risk Factor Surveillance System. We used a differences-in-differences framework, controlling for national trends and state differences, to estimate the effect of each benefit design factor on vaccination uptake in different Medicaid-eligible populations. Each additional dollar of copayment for vaccination decreased influenza vaccination coverage 1-6 percentage points. The effects of covering vaccines or prohibiting cost-sharing were mixed. Imposing copayments for vaccination is associated with lower vaccination coverage. These findings have implications for the implementation of Medicaid expansion in states that currently impose copayments.

Prior research indicates that cost-sharing and lack of insurance coverage reduce preventive services use among low-income persons. State Medicaid policy may affect the uptake of recommended adult vaccinations. We examined the impact of three aspects of Medicaid benefit design (coverage for vaccines, prohibiting cost-sharing, and copayment amounts) on vaccine uptake in the fee-for-service Medicaid population 19-64 years old. We combined previously published reports to obtain state Medicaid policy information from 2003 and 2012. Data on influenza vaccination uptake were taken from the Behavioral Risk Factor Surveillance System. We used a differences-in-differences framework, controlling for national trends and state differences, to estimate the effect of each benefit design factor on vaccination uptake in different Medicaid-eligible populations. Each additional dollar of copayment for vaccination decreased influenza vaccination coverage 1-6 percentage points. The effects of covering v...

As a health policy matter, coverage of immunizations and their administration for all ages at levels recommended by the Advisory Committee on Immunization Practices (ACIP) has grown in importance for several reasons: 1) the growing attention to both manmade and naturally occurring public health threats; 2) recognition of the value of immunization to society; and 3) the relatively high cost of at least certain immunization services in relation to personal income. No population stands to benefit more from immunization coverage than low income persons. Studies suggest that adult immunization status is particularly low, and that financial barriers play a role, especially for low income persons. Medicaid is the nation's single largest source of health insurance for children and adults. Eligibility for adults is linked to both membership in a recognized categorical status and low income, including individuals age 65 and over, adults (mostly women) in families with children, individuals with disabilities, pregnant women, and certain other categorical groups. This review is the second in a series of studies which describes the different health insurance coverage options available to individuals and families in the United States for acquiring medically appropriate immunizations. This report analyses the provision of immunization services to adult beneficiaries of Medicaid. Coverage and payment information was reviewed from every state, while data from the District of Columbia was unobtainable. The findings from this study are the following: 48 state Medicaid programs furnish at least some immunization coverage and payment for adult immunizations for non-institutionalized adult beneficiaries. Only Alaska and Louisiana specifically exclude immunization coverage for adults. 32 states offer coverage at ACIP standards. The most commonly offered vaccines are pneumococcal (48/48) and influenza, (44/48) with the least common vaccines being Hepatitis A (38/48) and meningococcal (39/48) vaccine. Cost sharing is virtually universal. Copayments are required in 27 states, prohibited in 1 state, and 20 states are silent. Vaccine replacement programs are almost non-existent. Only 3 states offer full vaccine replacement. There is great variation in the extent to which states will pay a separate administration fee. Fees are permissible in 26 states. In 15 states, the existence of a fee for administration is assumed as part of a rate setting method. 1 state prohibits any administration fee, and information was not obtained from 6 states. All states prohibit any payment to the extent that immunizations are offered free of charge. In our discussions with state Medicaid officials, it became evident that there was relatively widespread assumption that vaccines for adults can be secured free of charge and that coverage and payment are not an issue. The two states that exclude coverage and payment, do so entirely on the basis of this assumption. Our definition of comprehensive Medicaid immunization coverage includes coverage of all ACIP recommended vaccines, elimination of copayment requirements, a vaccine replacement policy, and payment of a separate fee. No state met that standard. By permitting nominal copayments meeting federal standards, 2 states, New York and California satisfy the test. We recommend conducting a technical assistance effort aimed at expanding the regulation of Medicaid immunization coverage, including developing a state-by-state analysis, targeted efforts to improve coverage levels as well as payments for replacement and administration. Additionally, we should ensure that public health agencies understand the Medicaid billing requirements, since the revenues generated through adult vaccine billing could be considerable in those states with relatively high Medicaid eligibility levels.

Medicaid is the largest funding source of health services for the poorest people in the United States. Medicaid enrollees have greater health care, needs, and higher health risks than other individuals in the country and, experience disproportionately low rates of preventive care. Without, Medicaid coverage, poor uninsured adults may not be vaccinated or would, rely on publicly-funded programs that provide vaccinations. We examined each programs' policies related to benefit coverage and, copayments for adult enrollees. Our study was completed between October 2011 and September 2012 using a document review and a survey of Medicaid administrators that assessed coverage and cost-sharing policy for fee-for-service programs. Results were compared to a similar review, conducted in 2003. Over the past 10 years, Medicaid programs have typically maintained or expanded vaccination coverage benefits for adults and nearly half have explicitly prohibited copayments. The 17 programs that cover all recommended vaccines while prohibiting, copayments demonstrate a commitment to providing increased access to vaccinations for adult enrollees. When developing responses to fiscal and political challenges, the programs that do not cover all ACIP recommended adult vaccines or those that permit copayments for vaccinations, should consider all strategies to increase vaccinations and reduce costs to enrollees.

In this paper we present a novel cluster paradigm and silicon operating system. Our approach in developing the competent cluster design revolves around an execution model to aid the execution of multiple independent applications simultaneously on the cluster, leading to cost sharing across applications. The execution model should envisage simultaneous execution of multiple applications (running traces of multiple independent applications in the same node at an instant, without time sharing) and on all the partitions(nodes) of a single cluster, without sacrificing the performance of individual application, unlike in the current cluster models. Performance scalability is achieved as we increase the number of nodes, the problem size of the individual independent applications, due to non-dependency across applications and hence increase in the number of non-dependent operations( as the problem sizes of the applications get increased) and this leads to better utilization of the unused resources within the node. This execution model is very much dependent on the node architecture for performance scalability. This would be a major initiative towards achieving performance Cost-Effective Supercomputing.

Objective: Given the importance of health insurance for financing medicines and recent policy changes designed to reduce health-related outof-pocket expenditure (OOPE) in Mexico, our study examined and analyzed the effect of health insurance on the probability and amount of OOPE for medicines and the proportion spent from household available expenditure (AE) funds. Methods: We conducted a cross-sectional analysis by using the Mexican National Household Survey of Income and Expenditures for 2008. Households were grouped according to household medical insurance type (Social Security, Seguro Popular, mixed, or no affiliation). OOPE for medicines and health costs, and the probability of occurrence, were estimated with linear regression models; subsequently, the proportion of health expenditures from AE was calculated. The Heckman selection procedure was used to correct for self-selection of health expenditure; a propensity score matching procedure and an alternative procedure using instrumental variables were used to correct for hetero-geneity between households with and without Seguro Popular. Results: OOPE in medicines account for 66% of the total health expenditures and 5% of the AE. Households with health insurance had a lower probability of OOPE for medicines than their comparison groups. There was heterogeneity in the health insurance effect on the proportion of OOPE for medicines out of the AE, with a reduction of 1.7% for households with Social Security, 1.4% for mixed affiliation, but no difference between Seguro Popular and matched households without insurance. Conclusion: Medicines were the most prevalent component of health expenditures in Mexico. We recommend improving access to health services and strengthening access to medicines to reduce high OOPE.

The sharing economy and collaborative consumption provide new opportunities in health care, especially to physicians, medical organizations, and consumers (patients). In health care services, there has been a long debate on the implementation and the characteristics of such concepts. Both terms may be very cost-effective, if applied accordingly. The aim of this paper was to investigate whether the concepts of sharing economy and collaborative consumption can be successfully used in health care services, with a specific interest in Ophthalmology services. The conclusions reached revealed that sharing economy in Ophthalmology services should be used from a consumer perspective, whereas the collaborative consumption concept should be used from a provider’s perspective.

Market share OPEC lost in defending higher prices fiom 1979-1985 is being steadily regained and is projected to exceed 50% by 2000. World oil markets are likely to be as vulnerable to monopoly influence as they were 20 years ago, as OPEC regains lost market share. The U.S. economy appears to be as exposed as it was in the early 1970s to losses from monopoly oil pricing. A simulated 2-year supply reduction in 2005-6 boosts OPEC revenues by roughly half a trillion dollars and costs the U.S. economy an approximately equal amount. The Strategic Petroleum Reserve appears to be of little benefit against such a determined, multi-year supply curtailment either in reducing OPEC revenues or protecting the U.S. economy. Increasing the price elasticity of oil demand and supply in the U.S. and the rest of the world, however, would be an effective strategy. The authors wish to thank Phil Patterson and Barry McNutt for their interest and support, and colleagues Jerry Hadder and Randy Curlee for their comments on earlier drafts. Any remaining errors are the author's responsibility. This report is dedicated to Michael Greene. vii 'Prices in this paper are 1993 dollars, except where indicated otherwise.

In conventional power systems, upstream and downstream of power were distinct. However, due to the competition, power injection and sink can appear at unexpected locations, and cost sharing for such a new power system configuration must be considered. This paper proposes a scheme for transmission expansion cost allocation among electric market participants by using Core and Nucleolus concepts of game theory, which are developed particularly for the transmission users. A solution of the n-person cooperative game is adopted to distribute the line transmission expansion cost among the players. Congestion is assumed to be the transmission constraint, and expansion of transmission line is expected to relieve transmission congestion. A case study is illustrated to demonstrate the proposed method.

This Research Report examines Medicare Advantage (MA) as a source of expanded Medicare benefits that integrates Medicare benefits with selected supplemental coverage. MA provides plan sponsors with considerable flexibility in how they structure MA benefits. While MA plans must cover mandated Part A and Part B benefits, they have the flexibility to modify cost sharing and other benefit features if the results are at least actuarially equivalent and nondiscriminatory. The report examines how these plans modify the structure of Medicare Part A and Part B benefits and cost sharing requirements, and what that means for the financial protection provided to plan enrollees. The report also compares MA's benefit structure with those of the standardized Medigap options created in 1990. Such analysis is important because the traditional Medicare benefit structure leaves beneficiaries financially exposed to an extent that is increasing over time with inflation in health care. With 23 percent of Medicare beneficiaries now enrolled in MA (including one in three persons with Part D coverage), it is increasingly relevant to understand what protection MA does and does not provide. The analysis of MA benefit design is based on files we created from the downloadable files the Centers for Medicare and Medicaid Services (CMS) provides with data from Medicare Options Compare, a tool used to support beneficiary choice. Data are for 2008 and 2009, with most statistics weighted by plan enrollment in July 2008.

To evaluate patients willingness to share the costs of 2 medications (often described as &quot;lifestyle medications&quot;): sildenafil for erectile dysfunction and finasteride for hair loss, which are not routinely covered by the Department of Veterans Affairs (VA) healthcare system. Self-administered, anonymous survey. Adult men (n = 339) were recruited from waiting rooms for primary care or erectile dysfunction clinic appointments at 2 Los Angeles VA facilities. Participants with self-reported need were analyzed separately for finasteride (primary care patients only) and sildenafil (both primary care and erectile dysfunction clinic patients). The mean age of the participants was 56 and 60 years for the finasteride and sildenafil groups, respectively. Mean annual household income for both groups was under $10,000. Respondents reported a mean willingness to cost-share $4.20 for a 30-day prescription of daily finasteride (VA wholesale cost = $27) and $5.40 for 4 sildenafil pills (VA...

Choosing a project for which benets accrue to all involved agents but brings major costs or additional benets to only one agent is often problematic. Siting a nationwide nuclear waste disposal or hosting a major sporting event are examples of such a problem: costs or benets are tied to the identity of the host of the project. Our goals are twofold: to choose the ecient site (the host with the lowest cost or the highest localized surplus) and to share the cost, or surplus, in a predetermined way so as to achieve redistributive goals. We propose a simple mechanism to implement both objectives. The unique subgame-perfect Nash equilibrium of our mechanism coincides with truthtelling, is ecient, budgetbalanced and immune to coalitional deviations. * HEC Montréal, Institut d'Économie Appliquée and CIRPÉE. † We are grateful for stimulating conversations with Francis Bloch, Lars Ehlers, Hervé Moulin, Nicolas Sahuguet and Bernard Sinclair-Desgagné as well as for feedback from participants of the Montreal Natural Resources and Environmental Economics Workshops and the Economics Workshop of HEC Montréal.

The recent literature on cost allocation lacks consensus on what is an appropriate de…nition of the consistency axiom. We take this as evidence that a careful reexamination is necessary. The starting point of our critique is the widely adopted de…nition proposed in , which we show to be conceptually ‡awed. Rectifying this ‡aw leads to a de…nition of consistency which already appeared in the recent literature though without satisfactory conceptual justi…cation. We o¤er a classi…cation of the existing de…nitions of the consistency axiom by relating them to the de…nitions of consistency in cooperative games suggested in and . We argue that only the latter leads to a meaningful interpretation of consistency when production externalities are present.

Since 1991 donors have advised sub-Saharan African universities to prepare "strategic plans". Universities should embark on strategic planning because they believe it has value in its own right, independently of whether it may release donor funds. Restructuring the relationship with government is a vital dimension. The plan as a document, to be publicized and negotiated, also takes on greater significance than Northern planning models allow. It must show how the university can serve its society, so the making must tap the skills and energies of academic colleagues. But engaging their co-operation in determining academic priorities has been a repeated difficulty. Much training is required, and a high premium is placed on the vice-chancellor's leadership. Continuous support from consultants helps, but the university must take ownership of the plan. The strategic plans which have been produced are considerable achievements. The form of strategic planning should be very different, certainly in detail and maybe in broad shape, in African universities than in their Northern counterparts. Opportunities for planners in Africa to learn from each other and to develop models appropriate to their circumstances will be of vital importance. <