Modern monetary theory for the post-pandemic NHS: why budget deficits do not matter

NHS clinical directors are responsible for balancing departmental budgets, which can encompass staffing, equipment and operating theatres. As trust income is generally fixed, expenditure reduction is often attempted via recurrent cost improvement plans. In orthodox monetary theory, a departmental deficit contributes first to the hospital, then to the NHS, then to the national deficit. In the orthodox view, governments in deficit need to increase taxes and/or borrow money by issuing bonds (akin to mortgage loans), the interest on which is paid off for generations. Modern monetary theory offers a different perspective: government deficits do not matter as much as orthodox theory claims, if at all. This is because governments have the monopoly right to create the money in which the deficit is denominated (so do not ever need to borrow something that they can create). Therefore governments cannot default on debt in their own currency. Furthermore, government deficits equate to private surplus. This new perspective should influence microeconomic budget management at the clinical director level: the new emphasis being to deliver value and not just implement local savings to eliminate departmental deficits. This approach will become increasingly important in managing the huge surgical waiting lists that have accumulated during the COVID-19 pandemic.

Cost and Efficiency in Government Outsourcing: Evidence from the Dredging Industry

This paper investigates the how government outsourcing affects efficiency and expenditures by considering how outsourcing decisions are determined along two dimensions: (i) cost differences between private firms and government suppliers of public goods and (ii) dynamics arising from cost complementarities and capacity constraints. I formulate and estimate a dynamic model of government outsourcing using project-level data from the dredging industry. Model estimates indicate substantial cost savings due to outsourcing but also that government presence in the market yields cost reduction. A counterfactual policy featuring direct competition between government and private sector firms finds a total expenditure reduction of 15.7 percent. (JEL D44, H41, H57, L84)

Low Cost Well Innovative for Slim Hole Application in East Malaysia Marginal Fields

This paper describes a step change by well completion group in adopting Single Trip Liner Open Hole Completion (STRIP-LOC) technology, basis of selection, design, and operation approach. This has contributed to the reduction in initial well cost estimates thus benefited overall project cost. The technology adoption signifies the importance for continuous design improvement, operational optimization, and capital expenditure reduction, while not compromising with technical and HSE standards.

Heat consumption analysis and energy-saving renovation of building heating in high sunshine heating area

In order to explore the effect and influence of energy-saving renovation on buildings in high sunshine heating area, the method of visit survey is used. The main scope of reconstruction includes: building windows, walls, door joints, pipe net-work, insulation measures, etc. The heat consumption of buildings, the comprehensive effect of improvement, and the satisfaction of residents are studied. The results show that after the energy-saving renovation of buildings and equipment in the heating area, compared with before the renovation, the residents' awareness of saving heating has been greatly improved and the waste has been significantly reduced. With the decrease of heating economic expenditure, people are more satisfied with energy-saving renovation. Both heating companies and individual users have been relatively large expenditure reduction. To sum up, it is very important to improve the energy efficiency of buildings in high sunshine heating area. After the energy-saving renovation of the building, not only the awareness of saving is improved, but also the consumption of resources are reduced, so that more people can enjoy the warmth. A win-win situation in the cost of users and heating companies is achieved. This study has a positive effect on the follow-up research of building energy-saving renovation in heating area.

OP152 Pharmacoeconomic Assessment And Drug Expenditure Reduction In Ireland

IntroductionAll new products to be reimbursed from the Irish health budget are subject to a rigorous assessment by the National Centre for Pharmacoeconomics (NCPE). Following assessment, a recommendation is made regarding its cost-effectiveness at the submitted price. This may lead a reduction in the drug price. This study aimed to determine the reduction in expenditure due to the pharmacoeconomic assessment process in Ireland.MethodsProduct details, submitted price and gross budget impact were recorded for each NCPE submission from 2012 to 2015. The latter was chosen as reimbursement data are currently available until 2016. A product was included if its assessment suggested price reduction was required and the product was reimbursed under the High-Tech Drug Scheme (HTDS), a scheme for high cost drugs in a primary care setting. The utilization and actual expenditure of each product was extracted from national reimbursement data for the year after approval. The expected expenditure, calculated using the submitted price, was then compared to the actual expenditure.ResultsA total of 162 products were assessed during the study period. There was a potential price reduction for 65 products based on the assessment outcome. Of these, 15 were reimbursed under the HTDS. A reduction in expenditure was evident for eight of the 15 products (53 percent). The average reduction was eight percent of the expected expenditure. All products showed an actual expenditure greater the predicted budget impact submitted by the applicant.ConclusionsTo the authors’ knowledge, this is the first report of expenditure reduction due to a pharmaco-economic assessment process. With the ever-increasing utilization of high cost drugs, the study demonstrates the importance of a process to assess and negotiate cost-effective drug prices. However, the study underestimates reductions, as it is yet to include commercial rebates returned to a central budget. Future research will aim to capture these reductions.

Minimization of Hydrodynamic Power Losses in Oscillating Submerged Structures by a Novel Shape-Morphing Strategy

In this paper, we investigate the two dimensional fluid-structure interaction problem of the oscillation of a shape-morphing plate in a quiescent, Newtonian, viscous fluid. The plate is considered as a moving wall for the fluid undergoing two concurrent periodic motions: a rigid oscillation along its transverse direction coupled to a shape-morphing deformation to an arc of a circle with prescribed maximum curvature. Differently from studies concerned with passive flexible structures, here, we introduce the prescribed deformation to specifically manipulate vortex-shedding and modulate hydrodynamic forces and energy losses during underwater oscillations. Computational fluid dynamics simulations are performed to evaluate the effect of the prescribed deformation strategy on the added mass and damping effect along with the hydrodynamic power dissipation. We observe that a minimum in the hydrodynamic power dissipation exists for an optimum curvature of the plate. This finding may allow significant power expenditure reduction in underwater vibrating systems where minimization of energy losses or maximization of quality factor are desirable.