The Long-Term Returns of Obesity Prevention Policies

This study illustrates the importance for policymakers of long-termbudget impact analyses of preventive health policies, specifically those aimed at obesity prevention. The study recommends that the Congressional Budget Office (CBO), the agency responsible for estimating costs of proposed federal legislation, develop the capacity to estimate the costs of these policies over a 75-year horizon.Obesity rates have doubled among adults in the last twenty years and tripled among children in a single generation. Evidence suggests that by 2040 roughly half the adult population may be obese. Obesity increases the risk of type 2 diabetes, high blood pressure, heart disease, certain types of cancer, stroke, and many other diseases and conditions. These associated conditions carry high financial costs and can be devastating to quality of life. Health care spending due to obesity is estimated to be as high as $210 billion annually, or 21 percent of total national health care spending. When also accounting for the nonmedical costs of obesity, the overall annual cost is estimated to be$450 billion.The Institute of Medicine and other scientific bodies have identified evidence-based strategies for addressing the childhood obesity epidemic. One impediment to pursuing obesity prevention policies at the federal level lies in how their budgetary impacts are assessed. CBO generally uses a ten-year budget window, but effective preventive health measures can have long-run budgetary impacts that differ greatly from their ten-year projections. In fact, very little of the federal savings they induce may be captured in the first decade, especially if an intervention is geared toward children or young adults and yields meaningful impacts on health care costs for individuals receiving Medicare decades in the future. In addition to distorting policymakers' understanding of the net cost of preventive health policies, a narrow budget window also fails to distinguish between effective and ineffective interventions. Because a ten-year window misses most or all of the savings from an effective obesity prevention policy, a tenyear cost estimate for such a policy would not differ from a ten-year estimate for an ineffective one.This study constructs an illustrative model of the long-term budget impact of obesity prevention policies, accounting for the Medicaid, Medicare, Social Security, and tax effects of preventing obesity. The model demonstrates the complexities involved in reaching a long-term cost estimate. Using four obesity prevention policies and programs as examples, the model generates lifetime (i.e., 75-year) percapita savings estimates for different types of people. In so doing, it makes it possible to compare the discrepancy between 75-year and ten-year cost estimates of a policy to prevent obesity

The Role of Maintenance and Facility Management in Logistics: A Literature Review

Purpose - The purpose of this paper is to provide a literature review on the different ways of carrying out Facility Management and related topics in order to uncover that there is limited research regarding the impact of Facility Management on the logistics and operational performance of warehouses. Design/methodology/approach - Four different focus areas have been identified and for each one different methodologies and streams of research have been studied. Findings - The study underlines the importance of Facility Management for the logistics operations; therefore it supports the notion that investments aiming at preserving the status of the building and service components of warehouses are crucial. Originality/value - This paper aims to suggest to Facility Management managers that they can contribute to enhance business performance by designing effective Facility Management strategie

Predictive Modeling in Action: How 'Virtual Wards' Help High-Risk Patients Receive Hospital Care at Home

Describes a program to reduce hospitalizations by providing multidisciplinary case management and coordinated preventive care at home to chronic disease patients found to be at risk of emergency hospitalization by predictive modeling. Outlines challenges

Spatiotemporal modeling of schistosomiasis in Ghana: linking remote sensing data to infectious disease

More than 90% of the worldwide schistosomiasis burden falls on sub-Saharan Africa. Control efforts are often based on infrequent, small-scale health surveys, which are expensive and logistically difficult to conduct. The use of satellite imagery to predictively model infectious disease transmission has great potential for public health applications. The transmission of schistosomiasis, a disease acquired from contact with contaminated surface water, requires specific environmental conditions to sustain freshwater snails. If a connection between schistosomiasis and remotely sensed environmental variables can be established, then cost effective and current disease risk predictions can be made available. Schistosomiasis transmission has unknown seasonality, and the disease is difficult to study due to a long lag between infection and clinical symptoms. To overcome these challenges, we employed a comprehensive 15-year time-series built from remote sensing feeds, which is the longest environmental dataset to be used in the application of remote sensing to schistosomiasis. The following environmental variables will be used in the model: accumulated precipitation, land surface temperature, vegetative growth indices, and climate zones created from a novel climate regionalization technique. This technique, improves upon the conventional Köppen-Geiger method, which has been the primary climate classification system in use the past 100 years. These predictor variables will be regressed against 8 years of national health data in Ghana, the largest health dataset of its kind to be used in this context, and acquired from freely available satellite imagery data. A benefit of remote sensing processing is that it only requires training and time in terms of resources. The results of a fixed effects model can be used to develop a decision support framework to design treatment schemes and direct scarce resources to areas with the highest risk of infection. This framework can be applied to diseases sensitive to climate or to locations where remote sensing would be better suited than health surveys.Published versio

Fork in the Road: Alternative Paths to a High Performance U.S. Health System

Estimates the cost savings and coverage rates of three options for healthcare reform: an insurance exchange with no public plan, a public plan paying Medicare rates, and a public plan paying rates midway between Medicare and private plan rates

Customer-oriented risk assessment in Network Utilities

For companies that distribute services such as telecommunications, water, energy, gas, etc., quality perceived by the customers has a strong impact on the fulfillment of financial goals, positively increasing the demand and negatively increasing the risk of customer churn (loss of customers). Failures by these companies may cause customer affection in a massive way, augmenting the intention to leave the company. Therefore, maintenance performance and specifically service reliability has a strong influence on financial goals. This paper proposes a methodology to evaluate the contribution of the maintenance department in economic terms, based on service unreliability by network failures. The developed methodology aims to provide an analysis of failures to facilitate decision making about maintenance (preventive/predictive and corrective) costs versus negative impacts in end-customer invoicing based on the probability of losing customers. Survival analysis of recurrent failures with the General Renewal Process distribution is used for this novel purpose with the intention to be applied as a standard procedure to calculate the expected maintenance financial impact, for a given period of time. Also, geographical areas of coverage are distinguished, enabling the comparison of different technical or management alternatives. Two case studies in a telecommunications services company are presented in order to illustrate the applicability of the methodology