Evaluating Payments for Watershed Services Programs in the United States

2019 ◽  
Vol 05 (04) ◽  
pp. 1950003
Author(s):  
Margaret Walls ◽  
Yusuke Kuwayama
Keyword(s):  
United States ◽  
Cost Savings ◽  
Cost Effective ◽  
The United States ◽  
Program Outcomes ◽  
Marginal Value ◽  
Funding Sources ◽  
Additional Water ◽  
Watershed Services ◽  
Payment Mechanisms

We review 15 forest watershed protection programs in the United States in which a local government agency or water provider collects payments from downstream service beneficiaries, such as water consumers, and pays upstream forest landowners for provision of watershed services. We describe the features of these Payments for Watershed Services (PWS) programs, focusing on funding sources, how the payment mechanisms work, and outcomes achieved. We also assess the extent to which the programs adhere to the economic principles that are associated with efficient or cost effective PWS schemes. In general, we find that payments in the programs do not closely reflect the marginal value of the service provided. Payments received by landowners mainly reflect the landowners’ opportunity costs. Fees paid by water consumers are set to yield revenue targets and/or reflect the avoided cost of additional water filtration and treatment. The programs appear to yield societal benefits, primarily through cost savings, but data from program outcomes is limited and more rigorous analysis of both the benefits and costs would be worthwhile.

scholarly journals Surgical instrumentation: the true cost of instrument trays and a potential strategy for optimization

2015 ◽  
Vol 4 (6) ◽  
pp. 82 ◽  
Author(s):  
Julie M. Mhlaba ◽  
Emily W. Stockert ◽  
Martin Coronel ◽  
Alexander J. Langerman
Keyword(s):  
United States ◽  
Cost Savings ◽  
Cost Effective ◽  
The United States ◽  
Waste Reduction ◽  
Significant Cost ◽  
Instrument Type ◽  
Hospital Revenue ◽  
Potential Strategy ◽  
The Cost

Objective: Operating rooms (OR) generate a large portion of hospital revenue and waste. Consequently, improving efficiency and reducing waste is a high priority. Our objective was to quantify waste associated with opened but unused instruments from trays and to compare this with the cost of individually wrapping instruments.Methods: Data was collected from June to November of 2013 in a 550-bed hospital in the United States. We recorded the instrument usage of two commonly-used trays for ten cases each. The time to decontaminate and reassemble instrument trays and peel packs was measured, and the cost to reprocess one instrument was calculated.Results: Average utilization was 14% for the Plastic Soft Tissue Tray and 29% for the Major Laparotomy Tray. Of 98 instruments in the Plastics tray (n = 10), 0% was used in all cases observed and 59% were used in no observed cases. Of 110 instruments in the Major Tray (n = 10), 0% was used in all cases observed and 25% were used in no observed cases. Average cost to reprocess one instrument was $0.34-$0.47 in a tray and $0.81-$0.84 in a peel pack, or individually-wrapped instrument.Conclusions: We estimate that the cost of peel packing an instrument is roughly two times the cost of tray packing. Therefore, it becomes more cost effective from a processing standpoint to package an instrument in a peel pack when there is less than a 42%-56% probability of use depending on instrument type. This study demonstrates an opportunity for reorganization of instrument delivery that could result in a significant cost-savings and waste reduction.

scholarly journals High Costs of Dialysis Transportation in the United States: Exploring Approaches to a More Cost-effective Delivery System

10.36469/9861 ◽  
2013 ◽  
Vol 1 (2) ◽  
pp. 134-150 ◽  
Author(s):  
J. Mark Stephens ◽  
Samuel Brotherton ◽  
Stephan C. Dunning ◽  
Larry C. Emerson ◽  
David T. Gilbertson ◽  
...  
Keyword(s):  
United States ◽  
Public Transportation ◽  
Cost Savings ◽  
Cost Effective ◽  
The United States ◽  
Levels Of Care ◽  
Dialysis Facility ◽  
Effective Delivery ◽  
Stage Renal Disease ◽  
End Stage

Background: The costs of transporting end-stage renal disease (ESRD) patients to dialysis centers are high and growing rapidly. Research has suggested that substantial cost savings could be achieved if medically appropriate transport was made available and covered by Medicare. Objectives: To estimate US dialysis transportation costs from a purchaser’s perspective, and to estimate cost savings that could be achieved if less expensive means of transport were utilized. Methods: Costs were estimated using an actuarial model. Travel distance estimates were calculated using GIS software from patient ZIP codes and dialysis facility addresses. Cost and utilization estimates were derived from fee schedules, government reports, transportation websites and peer-reviewed literature. Results: The estimated annual cost of dialysis transportation in the United States is $3.0 billion, half of which is for ambulances. Most other costs are due to transport via ambulettes, wheelchair vans and taxis. Approximately 5% of costs incurred are for private vehicle or public transportation use. If ambulance use dropped to 1% of trips from the current 5%, costs could be reduced by one-third. Conclusions: Decision-makers should consider policies to reduce ambulance use, while providing appropriate levels of care.

scholarly journals Cost-Effective Use of White Blood Cell Growth Factors in the Veterans Administration

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4761-4761
Author(s):  
Kevin Knopf ◽  
William Hrureshky ◽  
Bryan Love ◽  
Leann Norris ◽  
Charles L. Bennett
Keyword(s):  
United States ◽  
Survey Data ◽  
Conflicts Of Interest ◽  
Cost Savings ◽  
Cost Effective ◽  
The United States ◽  
Convincing Evidence ◽  
Cost Driver ◽  
Veterans Administration ◽  
Va Health Care System

Abstract The use of granulocyte colony-stimulating (G-CSF) factors to avoid chemotherapy induced neutropenia is a major cost driver in clinical oncology. Short acting formulations, while less convenient, are 39% the cost of the longer formulation (Pegfilgrastim). We analyzed the use of G-CSF vs. Neulasta in the Veterans Administration (VA) health care system as currently practiced by clinical judgement and analyzed this economically. A survey of 23 sites within the VA on the relative frequency of use of filgrastim, Tbo-filgrastim, Filgrastim-sndz and Pegfilgrastim was conducted. Cost was estimated using 340B pricing. A maximally cost-effecient strategy of 100% Tbo-filgrastim would result in a cost of $62,336 per 100 patient episodes. Tbo-filgrastim was the preferred treatment in 18 of 23 sites surveyed. Cost results ranged from a minimum of $62,336 (4 of 23 sites) to a maximum of $201,356 (2 of 23 sites) with a mean cost of $99,080. The VA was overall 73% efficient, and therefore highly cost-effective, in minimizing use of Pegfilgrasim. As in Europe cost-efficiency favors the use of Tbo-filgrastim over Pegfilgrastim; further cost-saving opportunities exist with the following strategies : (1) avoid G-CSF use where there is no convincing evidence of efficacy (i.e. low risk patients, treatment of neutropenia rather than prophylaxis) (2) use daily filgrastim in lieu of pegfilgrastim whenever possible (3) use Tbo-filgrastrim rather than filgrastrimn (4) continue to examine strategies using 2 or 4 day courses of G-CSf as opposed to 8 days which would cut cost an additional 50 to 75%. Survey data showed that uptake of biosimilar G-CSF in the VA system has been extremely rapid. All sites are using biosimilar GCSF for all new patients; 6 of 23 sites were comfortable shifting current patients on branded G-CSF to the biosimilar. Survey data shows an overwhelming use of filgrastrim compared to pegfilgrastim in the VA system, in contradistinction to the rest of the United States - resulting in an efficiency of 73% (i.e. only 27% of patients are being given pegfilgrastrim). This represents a great savings to the VA system which can be emulated in other sites in the United States. Switching to a Tbo-filgrastim, although heralded by some as cost savings, only engendered a cost savings of 2.2% - small compared to other clinical changes. Disclosures No relevant conflicts of interest to declare.

Reinventing Distribution

2020 ◽  
pp. 64-78
Author(s):  
Lea Shaver
Keyword(s):  
United States ◽  
Developing Countries ◽  
Cost Savings ◽  
Cost Effective ◽  
The United States ◽  
Hard Copy ◽  
Digital Content ◽  
Potential Cost ◽  
Trade Off ◽  
Children’S Homes

This chapter covers the difficulties of distributing books, especially developing countries that contend with limited transportation infrastructure and unreliable postal systems. From Pratham Books' perspective, “Creating access is infinitely harder than creating books,” Suzanne Singh states plainly. It explains how postal systems offer a convenient and cost-effective way to deliver hard-copy books. In the United States, Imagination Library spends pennies per book to ship directly to children's homes. The trade-off, however, is that the recipients have no ability to select particular books of interest. The chapter also explains how digital technology offers to make books “magically appear” in a different way. For charities looking to make their budgets stretch, these potential cost savings are significant and very attractive. For this reason, literacy charities in the developing world are increasingly emphasizing digital content.

Metam Sodium Combined with Chloropicrin as an Alternative to Methyl Bromide Fumigation for Tomato

HortScience ◽  
1998 ◽  
Vol 33 (3) ◽  
pp. 525b-525 ◽  
Author(s):  
S.J. Locascio ◽  
D.W. Dickson
Keyword(s):  
United States ◽  
Lycopersicon Esculentum ◽  
Pest Control ◽  
Methyl Bromide ◽  
Soil Fungi ◽  
Good Control ◽  
The United States ◽  
Metam Sodium ◽  
Additional Water ◽  
Phase Out

In past work, dichloropropene + 17% Pic (1,3-D + Pic) at 327 L·ha–1 plus pebulate provided good control of nematode, soil fungi, and nutsedge in mulched tomato (Lycopersicon esculentum Mill.) and is considered the best alternative for methyl bromide (MBr) + chloropicrin (Pic), which is scheduled for phase-out in the United States by Jan. 2001. Metam-sodium did not provide acceptable pest control. In the present study, metam-Na (295 L·ha–1 combined with Pic (168 kg·ha–1) + 4.5 kg·ha–1 pebulate, and 1,3-D + 35% Pic at 168 and 225 L·ha–1 + pebulate were compared to MBr-Pic (98-2% at 345 kg·ha–1 and 67-33% at 505 kg·ha–1). Fumigants were injected into the bed except metam-Na and pebulate were surface-applied and incorporated and drip tubing and mulch were applied. Marketable yields with MBr-Pic, 225 L·ha–1 1,3-D + Pic, and metam-Na + Pic were higher than with the check. Yields with metam-Na alone or with additional water before transplanting were similar to the check. Nutsedge was controlled with MBr-Pic and all treatments with pebulate. Nematode root-gall ratings were high on tomato grown without fumigants (8.9 rating on a scale of 0 to 10 with 0 = no galling), low with MBr-Pic (0.33), and intermediate with all other treatments (2.2 to 5.5) except with 168 L·ha–1 1-3-D + Pic (8.3). This study indicates that metam-Na + Pic + pebulate also is a possible alternative to MBr-Pic for tomato.

The Three Rs in Research and Education: A Long Road Ahead in the United States

1996 ◽  
Vol 24 (2) ◽  
pp. 151-158 ◽  
Author(s):  
F. Barbara Orlans
Keyword(s):  
United States ◽  
Animal Experiments ◽  
The United States ◽  
Education Student ◽  
Funding Sources ◽  
Research And Education ◽  
The Right ◽  
Student Projects ◽  
Institutional Oversight ◽  
The Three Rs

Attitudes toward the Three Rs concept of refinement, reduction and replacement in the United States in research and education are widely divergent. Positive responses have come from several sources, notably from four centres established to disseminate information about alternatives. Funding sources to support work in the Three Rs have proliferated. The activities of institutional oversight committees have resulted in the nationwide implementation of important refinements. In the field of education, student projects involving pain or death for sentient animals have declined, and the right of students to object to participation in animal experiments on ethical grounds has been widely established. However, there is still a long way to go. Resistance to alternatives is deep-seated within several of the scientific disciplines most closely associated with animal research. The response of the National Institutes of Health to potentially important Congressional directives on the Three Rs has been unsatisfactory. The prestigious National Association of Biology Teachers, which at first endorsed the use of alternatives in education, later rescinded this policy, because of opposition to it. An impediment to progress is the extreme polarisation of viewpoints between the biomedical community and the animal protectionists.

scholarly journals Cost effectiveness analysis of implementing tuberculosis screening among applicants for non-immigrant U.S. work visas

Pneumonia ◽  
2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Bisma Ali Sayed ◽  
Drew L. Posey ◽  
Brian Maskery ◽  
La’Marcus T. Wingate ◽  
Martin S. Cetron
Keyword(s):  
United States ◽  
Home Country ◽  
Screening Program ◽  
Cost Savings ◽  
The United States ◽  
Active Tuberculosis ◽  
Multiple Perspectives ◽  
Tuberculosis Screening ◽  
Hospitalization Costs ◽  
The U.S

Abstract Background While persons who receive immigrant and refugee visas are screened for active tuberculosis before admission into the United States, nonimmigrant visa applicants (NIVs) are not routinely screened and may enter the United States with infectious tuberculosis. Objectives We evaluated the costs and benefits of expanding pre-departure tuberculosis screening requirements to a subset of NIVs who arrive from a moderate (Mexico) or high (India) incidence tuberculosis country with temporary work visas. Methods We developed a decision tree model to evaluate the program costs and estimate the numbers of active tuberculosis cases that may be diagnosed in the United States in two scenarios: 1) “Screening”: screening and treatment for tuberculosis among NIVs in their home country with recommended U.S. follow-up for NIVs at elevated risk of active tuberculosis; and, 2) “No Screening” in their home country so that cases would be diagnosed passively and treatment occurs after entry into the United States. Costs were assessed from multiple perspectives, including multinational and U.S.-only perspectives. Results Under “Screening” versus “No Screening”, an estimated 179 active tuberculosis cases and 119 hospitalizations would be averted in the United States annually via predeparture treatment. From the U.S.-only perspective, this program would result in annual net cost savings of about $3.75 million. However, rom the multinational perspective, the screening program would cost $151,388 per U.S. case averted for Indian NIVs and $221,088 per U.S. case averted for Mexican NIVs. Conclusion From the U.S.-only perspective, the screening program would result in substantial cost savings in the form of reduced treatment and hospitalization costs. NIVs would incur increased pre-departure screening and treatment costs.

A Follow-On Biological Drug is not a Biogeneric: Lessons from Omnitrope and Valtropin

2009 ◽  
Vol 6 (3) ◽  
pp. 237-245 ◽  
Author(s):  
Robert I. Roth ◽  
Nicholas M. Fleischer
Keyword(s):  
United States ◽  
Therapeutic Proteins ◽  
Cost Savings ◽  
The United States ◽  
Substantial Cost ◽  
Biological Drugs ◽  
Biological Drug ◽  
Therapeutic Properties ◽  
Drug Developer ◽  
The Eu

Recent years have seen the approvals, more so in the EU than the United States, of follow-on biological drugs. These products have been new formulations of recombinant therapeutic proteins, developed to compete with the marketed originator products. Intended to closely mimic the originator products in terms of chemistry and therapeutic properties, these so-called ‘biosimilar’ products were initially conceived to be developed according to abbreviated development programmes, presumably at a substantial cost savings to both the drug developer and the consumer. With several such products now recently approved, however, it has become clear that their development programmes have been quite extensive and not particularly abbreviated. Accordingly, cost savings to consumers appear to be relatively modest.

Pension Enhancements and the Retention of Public Employees

ILR Review ◽  
2016 ◽  
Vol 70 (2) ◽  
pp. 519-551 ◽  
Author(s):  
Cory Koedel ◽  
P. Brett Xiang
Keyword(s):  
United States ◽  
Public Sector ◽  
Employee Retention ◽  
Cost Effective ◽  
The United States ◽  
Pension Plans ◽  
Public Employees ◽  
Public School Teachers ◽  
School Teachers ◽  
Public Pension Plans

The authors use data from workers in the largest public-sector occupation in the United States—teaching—to examine the effect of pension enhancements on employee retention. Specifically, they study a 1999 enhancement to the benefit formula for public school teachers in St. Louis, Missouri, that resulted in an immediate and dramatic increase in their incentives to remain in covered employment. To identify the effect of the enhancement on teacher retention, the analysis leverages the fact that the strength of the incentive increase varied across the workforce depending on how far teachers were from retirement eligibility when it was enacted. The results indicate that the St. Louis enhancement—which was structurally similar to enhancements that were enacted in other public pension plans across the United States in the late 1990s and early 2000s—was not a cost-effective way to increase employee retention.

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