Out-of-Pocket Spending for Cancer Medication, Financial Burden, and Cost Communication with Oncologists in the Last Six Months of Life in Israel

Honest communication between oncologists and patients is important in alleviating the financial burden of cancer care. This study explored patient–relative–oncologist communication regarding the affordability of out-of-pocket (OOP) medication and the extent to which this communication addresses itself to the families’ financial burden. A cross-sectional survey was conducted among primary caregivers of deceased cancer patients. About 43% of relatives said that they and/or the patients had paid out of pocket for medications during the last six months of the patient’s life. Most (73%) oncologists suggested an OOP medication without asking about financial ability, 43% hardly explained the advantages of an OOP medication, and 52% hardly explained any treatment alternatives. Older age and female gender were related to less communication about an OOP medication, and better education, greater affluence, and having private health insurance were related to more communication. About 56% of relatives said that OOP payment for medications inflicted a very heavy or heavy financial burden on patients and their households. Physicians’ interest in financial ability and giving explanation lightened the burden. Given the difficulty of explaining the complex interactions of cost and clinical outcomes, oncologists need to be better educated in skills that would enable them to communicate costs more openly and should consider the cost of a treatment when prescribing it.

Under- and over-investment in education: the role of locked-in fertility

This research argues that, in the presence of idiosyncratic ability shocks after childbirth, irreversible fertility decisions distort the resource allocation between the quantity and quality of children. In underdeveloped environments, where family size is locked into large levels, education investment places a heavy financial burden on households, which deprives some competent children of learning opportunities. In contrast, in more developed environments, family size is locked into smaller levels, which facilitates education investment even for some children with low aptitude. A redistributive policy to mitigate the distortion is proposed for each stage.

Hospitalization Expenditures and Out-Of-Pocket Expenses in Patients With Stroke in Northeast China, 2015–2017: A Pooled Cross-Sectional Study

Background: Stroke is the second most common cause of mortality worldwide and the leading cause of death in China. It imposes a heavy financial burden on patients, especially for some social groups that are vulnerable to economic risks.Objective: This study aimed to comprehensively assess the magnitude of hospital and out-of-pocket (OOP) costs associated with stroke in Northeast China.Methods: Patients were selected via a multistage stratified cluster random sampling approach. We reviewed all patients’ records from 39 hospitals across six cities in Liaoning Province between 2015 and 2017. Cost characteristics of four major stroke types were analyzed. Multivariate linear regression analyses were employed to examine the determinants of hospitalization costs and OOP expenses.Results: A total of 138,757 patients were assessed for the medical costs. The mean hospitalization costs were $1,627, while the mean OOP expenses were $691, accounting for 42.5% of the total expenditures. Medication expenses were the largest contributor to hospitalization costs. The regression analysis suggested that age, length of stay (LOS), social identity, type of stroke, surgery, intensive care unit (ICU) admission, hospital level and hospital type were significantly correlated with hospitalization costs and OOP expenses.Conclusion: Stroke imposes a heavy financial burden on both patients and society in Liaoning Province, Northeast China. Results showed that there are some differences in the individual and social economic burden among different types of stroke. In addition, stroke patients share a high proportion of costs through OOP expenses, especially for poor social-economic status patients. Targeted intervention measures and specific policies are needed to reduce the individual and social economic burden of stroke as well as improve equity in health care among different social groups.

IMPROVING CONSTRUCTION PROJECT PERFORMANCE IN DEVELOPING COUNTRIES: CONTRACTOR APPROACH

Achieving project success remains the aim of every project sponsor. The sponsor engages different professionals in the built environment to this end. However, unforeseen factors modify agreed terms, causing delay and leading to loss of time and money. Delay causes an overrun of cost and time having a heavy financial burden on the client and other stakeholders involved in the project. Most times, the contractor is always the focus when this happens. At many other times, other stakeholders, who failed in their obligations, only surface after a study of the contract conditions is carried out. Thus, this study examines project performance in the construction industry in Nigeria, but from a contractor’s perspective. The study adopts a survey research design. A total number of 75 questionnaires were administered to contractors, who were members of the Federation of Construction Industry and other private sector organizations, but 37 were successfully retrieved and analyzed. The result shows that to improve construction project performance in developing countries, the following issues need to be tackled: design and installation issues, payment issues and construction difficulties arising from incomplete designs by consultants. The study recommends, among other solutions, the incorporation of contractors from the project planning phase and adoption of BIM, which is presently not prevalent in the industry.

Legacies of Mega-Sporting Events in Developing Countries

This chapter engages with the scholarship that emphasizes the benefits of mega-sporting events to host countries, from increasing their international prestige and influence on global politics, through to mobilizing national pride, and serving as a tool of economic development. This chapter also investigates the benefits gained by Lebanon as a result of hosting four regional mega-sporting events since the civil war ended in 1990. Additionally, it examines the similarities and differences between these four events by exploring, in particular, the tangible and intangible legacies. Apart from a review of academic and press articles, primary data was collected by interviewing key stakeholders in the Lebanese sports sector who were involved in the events. Our conclusion is that while the events provided Lebanon with some short-term promotional benefits, they introduced a heavy financial burden, especially in relation to stadium and sports hall construction. Resources to maintain those facilities became a source for corruption.

On the Wheat Price Support Policy in Pakistan

Wheat is Pakistan's main food and strategic crop. Currently, the government controls wheat prices through a minimum support price (MSP) policy to encourage production. However, despite the increase in wheat production, input costs and output prices have been increasing over the years. This paper aims to analyse the impact of wheat support price policies. We use data from different government sources to estimate the financial implications of MSP and compare the support price policies of India and Pakistan. We find that Pakistan’s current minimum support price policy encourages farmers to produce larger quantities of wheat, but this places a heavy financial burden on the country's finances. Our results indicate that the higher MSP of wheat has made the country lose its competitiveness in the international market. Besides, we found that the cost of wheat production in Pakistan is much higher than in India. These higher production costs force the government to raise the MSP to maintain farmers' profitability. The high MSP is guaranteed by subsidizing the procurement and release of wheat, which imposes a heavy financial burden on government finances. In addition, the rise in wheat prices in recent years has also hurt consumers. Policymakers can redistribute subsidies by subsidizing wheat inputs, especially fertilizers and seeds, to reduce production costs. To this end, the best policy intervention may be to provide input subsidies rather than subsidies on purchase prices. A reduction in input costs will correspondingly reduce output prices, which will increase farmers' profitability, consumer surplus and the international competitiveness of Pakistani wheat.

Mechanism Design for an Incentive Subsidy Scheme for Bus Transport

Large public transport subsidies necessitated by operating deficits have become a heavy financial burden on some local governments. However, the present subsidy scheme lacks incentives to encourage bus operators to reduce deficits to lessen subsidies. In order to motivate bus operators to exert their roles in reducing these subsidies to ensure sustainable finance, this paper designs an incentive subsidy scheme based on the Laffont–Tirole model. This scheme is designed to motivate bus operators to endeavor to reduce deficits so as to obtain a premium, thus minimizing the total amount of subsidies and maximizing social benefit. The case of the bus network in Kumamoto, Japan, shows how, with this subsidy scheme, bus operators can play roles in lessening subsidies, allowing a win-win situation for both bus operators and the local government, and maximizing social benefit to realize the sustainability of the city. Finally, findings of our sensitivity analysis with imperfect information suggest that the length of bus lines in a network should be shortened in order to avoid cost waste to lessen subsidies.

Women and Laws in Early Medieval Europe

This article examines the main ways in which early medieval lawmakers concerned themselves with women. Law codes put forward ideologically loaded representations of women, and they reflected concerns to ensure both their protection and their control by men. At the same time, they also dealt with highly practical issues and were subject to continual amendment as new and ever more complicated cases were brought before lawmakers. They reveal a conflicted and ambiguous attitude towards women: as highly prized assets and a crucial form of symbolic capital, but also a heavy financial burden, a liability, and a weak point in the safeguarding of family honor. We consider the valuation of women in terms of compensation for homicide, injuries, and insults; the regulation of marriage and of sexual crimes; and property, to which women and men had differential access.

The ABCs of Children's Health Care: How the Medicaid Expansions Affected Access, Burdens, and Coverage between 1987 and 1996

The Medicaid poverty expansions were among the major health policy initiatives of the late 1980s. This paper examines changes over a nine-year period in access, burdens, and coverage among children eligible for Medicaid through the expansions. Among eligible children, the Medicaid expansions reduced rates of uninsurance, increased access to physicians, and reduced families' risk of bearing a heavy financial burden. Gaps remain, however, and expansion-eligible children are more likely than never-eligible children to have been uninsured, to have gone without a physician office visit, and to have lived in a family that spent at least 20% of family income on medical care.

Micronesia—A Changing Frontier

Dependent areas under American administration have always been a heavy financial burden on the American taxpayer. The Trust Territory of the Pacific Islands, comprising the whole of Micronesia except Guam, will certainly prove no exception. That Micronesia will prove an economic liability is, however, less important than the possibility that it will also be a heavy political liability.The humanitarian conscience of the Western world would in any case be quick to enforce its highest standard upon a rich government like that of the United States. A country striving to assert leadership in the development of backward areas all over the world will itself wish to meet these standards in its sole trust territory. However, the material well-being of the Micronesians when under Japanese rule, the great devastation wrought by the war, and the predominantly strategic interests so far dominant in the United States policy in the area—all will make it difficult even for a benevolent American administration to win the approval of the Micronesians. For it to make a record there which will help it in its struggle to win the confidence of colonial peoples elsewhere will be even more difficult.