The study provides estimates of the cost of various malaria control measures in an area of North-Central Province of Sri Lanka where the disease is endemic. We assumed that each measure was equally effective. In these terms, impregnating privately purchased bednets with insecticide was estimated to cost Rs 48 (US(40.87) per individual protected per year, less than half the cost of spraying houses with residual insecticides. Larviciding of vector breeding sites and especially the elimination of breeding habitats by flushing streams through seasonal release of water from upstream reservoirs was estimated to be cheaper than other preventive measures (Rs 27 (US$ 0.49) and Rs 13 (US$ 0.24) per individual protected, respectively). Inclusion of both operational and capital costs of treatment indicates that the most cost-effective intervention for the government was a centrally located hospital with a relatively large catchment area (Rs 71 (US$ 1.29) per malaria case treated). Mobile clinics (Rs 153 (US$ 2.78) per malaria case treated) and a village treatment centre (Rs 112 (US$ 2.04)) per malaria case treated) were more expensive options for the government, but were considerably cheaper for households than the traditional hospital facilities. This information can guide health planners and government decision-makers in choosing the most appropriate combination of curative and preventive measures to control malaria. However, the option that is cheapest for the government may not be so for the householders, and further studies are needed to estimate the effectiveness of the various preventive measures. (+info)
The economics of for-profit and not-for-profit hospitals.
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This paper examines the economics of for-profit and not-for-profit hospitals through the prism of capital acquisitions. The exercise suggests that of two hospitals that are equally efficient in producing health care, the for-profit hospital would have to charge higher prices than the not-for-profit hospital would, to break even on capital acquisitions. The reasons for this divergence are (1) the typically higher cost of equity capital that for-profit hospitals face; and (2) the income taxes they must pay. The paper recommends holding tax-exempt hospitals more formally accountable for the social obligation they shoulder, in return for their tax preference. (+info)
The value of the Ecological Station of Jatai's ecosystem services and natural capital.
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The capacity of a given natural ecosystem to provide certain goods and services that satisfy human needs depends on its environmental characteristics (natural processes and components). It was described the availability of these goods and services (environmental functions) controlled and sustained by ecological processes operating in Ecological Station of Jatai (Luiz Antonio, SP). The environmental functions identified were grouped in four main categories. To make environmental values an integrated factor in planning and decision making it was assessed their socio-economic importance in qualitative terms and, if possible their monetary value. The combined potential annual return from identified functions of Ecological Station of Jatai is at least US$ 708.83/ha/year. In comparison to calculations made for other natural ecosystems this is a rather moderate estimate. The Ecological Station of Jatai is poorly protected and managed, it too is still threatened by human activity (agriculture) and many development plans. Although present day market economics do not recognize the monetary value of most environmental functions, such calculations do provide a revealing insight into the great socio-economic importance of Ecological Station of Jatai. More awareness of these values may provide an important incentive for their preservation and sustainable use. (+info)
The impact of ageing on expenditures in the National Health Service.
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BACKGROUND: health policy makers in many countries have expressed concern over the pressures that increased numbers of older people will exert on health care costs. Previous studies have shown that, in addition to increasing size of older populations, per capita expenditures have risen disproportionately among the old compared to the middle age groups. Documentation of such trends is essential for more accurate projection of health expenditures. OBJECTIVE: we examined detailed national age-specific expenditure trends for England and Wales, comparing findings with Canada, Japan, and Australia. METHODS: we obtained total health expenditures for each age group from the UK Department of Health for time periods 1985-87 to 1996-99. We examined changes in age-specific per capita expenditure, population demographics, and the allocation of national expenditures to the different age groups. We then determined the association of changes in population, age structure, and age-specific per capita expenditure to increases in national health care expenditure for England and Wales, comparing results to Canada, Japan, and Australia. RESULTS: per capita health expenditures in England and Wales increased by 8% for ages 65 and over, compared to 31% for ages 5-64. Hence the proportion of total expenditures allocated to the population aged 65 and over decreased from 40% to 35%, a trend most noticeable for non-acute hospital costs. Demographic shifts and population growth accounted for only 18% of the observed increases in health care expenditures in England and Wales, compared to 68%, 44%, and 34% in Japan, Canada, and Australia respectively. CONCLUSIONS: in contrast to other countries, England and Wales had slower rises in per capita costs and a decreasing proportion of national expenditures allocated to older people. These differences invite future research into the actual demand drivers of these costs. (+info)
Cost savings of home nocturnal versus conventional in-center hemodialysis.
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BACKGROUND: Home nocturnal hemodialysis (HNHD) can improve clinical and biochemical factors in people with renal failure, but its cost-effectiveness relative to conventional in-center hemodialysis (IHD) is uncertain. We hypothesized that HNHD would provide more dialysis treatments at a lower total cost than IHD. METHODS: A prospective one-year descriptive costing study was performed at two centers in Toronto, Canada, involving patients enrolled from a HNHD program (N = 33), and a matched cohort from an IHD program (N = 23). All costs are expressed as mean weekly amount in Canadian year 2000 dollars. A projected mean annual cost (PMA) was calculated also. RESULTS: The mean number of treatments per week was much higher with HNHD (5.7 vs. 3.0, P = 0.004). Cost categories found to be less expensive for HNHD were staffing (weekly $210 vs. $423, P < 0.001, PMA $10,932 vs. $22,056) and overhead and support (weekly $80 vs. $238, P < 0.001, PMA $4179 vs. $12,393). There was a trend toward lower costs for hospital admissions and procedures (weekly $23 vs. $134, P = 0.355, PMA $1173 vs. $6997) and for medications ($172 vs. $231, P = 0.082, PMA $8989 vs. $12,029). Costs found to be more expensive for HNHD were the cost of direct hemodialysis materials (weekly $318 vs. $126, P < 0.001, PMA $16,587 vs. $6575) and capital costs (weekly $118 vs. $17, P < 0.001, PMA $6139 vs. $871), with a trend toward higher cost for laboratory tests (weekly $33 vs. $26, P = 0.094, PMA $1744 vs. $1364). Physician costs were the same at $128 per week (PMA $6650). The weekly mean total cost for health care delivery was 20% less for HNHD ($1082 vs. $1322, P = 0.006), with projected mean annual costs more than $10,000 lower ($56,394 vs. $68,935). CONCLUSIONS: HNHD provides about three times as many treatment hours at nearly a one-fifth lower cost, with savings evident even when only program and funding-specific costs are considered. (+info)
Social capital, poverty, and income inequality as predictors of gonorrhoea, syphilis, chlamydia and AIDS case rates in the United States.
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BACKGROUND: Social capital has been related to a number of important public health variables such as child welfare, mortality, and health status. However, the relation of social capital to infectious diseases has received relatively little attention. The relation of social capital to health measures is often posited to be related to the key societal variables of poverty and income inequality. Therefore, any exploration of the correlation between social capital and infectious diseases should also include examination of the association with poverty and income inequality. OBJECTIVE: This study examined the state level association between social capital, poverty, income inequality, and four infectious diseases that have important public health implications given their long term sequelae: gonorrhoea, syphilis, chlamydia, and AIDS. METHOD: A state level, correlational analysis (including bivariate linear correlational analysis, and multivariate linear stepwise regression analysis) was carried out. 1999 state level rates of gonorrhoea, syphilis, chlamydia, and AIDS were the main outcome measures. RESULTS: In bivariate analyses, poverty was significantly correlated with chlamydia; income inequality was significantly correlated with chlamydia and AIDS case rates; and social capital was significantly correlated with all outcome measures. In stepwise multiple regression analyses, social capital was always the strongest predictor variable. CONCLUSIONS: These results suggest that social capital is highly predictive of at least some infectious diseases. The results indicate the need for further research into this relation, and suggest the potential need for structural interventions designed to increase social capital in communities. (+info)
New frontier, new power: the retail environment in Australia's dark market.
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OBJECTIVE: To investigate the role of the retail environment in cigarette marketing in Australia, one of the "darkest" markets in the world. DESIGN: Analysis of 172 tobacco industry documents; and articles and advertisements found by hand searching Australia's three leading retail trade journals. RESULTS: As Australian cigarette marketing was increasingly restricted, the retail environment became the primary communication vehicle for building cigarette brands. When retail marketing was restricted, the industry conceded only incrementally and under duress, and at times continues to break the law. The tobacco industry targets retailers via trade promotional expenditure, financial and practical assistance with point of sale marketing, alliance building, brand advertising, and distribution. Cigarette brand advertising in retail magazines are designed to build brand identities. Philip Morris and British American Tobacco are now competing to control distribution of all products to retailers, placing themselves at the heart of retail business. CONCLUSIONS: Cigarette companies prize retail marketing in Australia's dark market. Stringent point of sale marketing restrictions should be included in any comprehensive tobacco control measures. Relationships between retailers and the industry will be more difficult to regulate. Retail press advertising and trade promotional expenditure could be banned. In-store marketing assistance, retail-tobacco industry alliance building, and new electronic retail distribution systems may be less amenable to regulation. Alliances between the health and retail sectors and financial support for a move away from retail dependence on tobacco may be necessary to effect cultural change. (+info)
Cost analysis of the built environment: the case of bike and pedestrian trials in Lincoln, Neb.
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We estimated the annual cost of bike and pedestrian trails in Lincoln, Neb, using construction and maintenance costs provided by the Department of Parks and Recreation of Nebraska. We obtained the number of users of 5 trails from a 1998 census report. The annual construction cost of each trail was calculated by using 3%, 5%, and 10% discount rates for a period of useful life of 10, 30, and 50 years. The average cost per mile and per user was calculated. Trail length averaged 3.6 miles (range = 1.6-4.6 miles). Annual cost in 2002 dollars ranged from 25,762 to 248,479 (mean = 124,927; median = 171,064). The cost per mile ranged from 5735 to 54,017 (mean = 35,355; median = 37,994). The annual cost per user was 235 (range = 83-592), whereas per capita annual medical cost of inactivity was 622. Construction of trails fits a wide range of budgets and may be a viable health amenity for most communities. To increase trail cost-effectiveness, efforts to decrease cost and increase the number of users should be considered. (+info)