Spacecraft cost estimation

Spacecraft subsystem cost estimatio

New York City\u27s Watershed Agreement: A Lesson in Sharing Responsibility

The New York City Watershed Agreement is a commitment of historic proportions. New York City\u27s financial commitments to land acquisition, Partnership Programs, and infrastructure and water quality improvements totals over $1.2 billion. New York State commitments to land acquisition and partnership programs amount to more than$53 million and federal commitments under the 1996 Safe Drinking Water Act Amendments total $105 million. This level of financial commitment represents New York City\u27s understanding that the financial burden of clean drinking water should be borne primarily by those who enjoy it. The financial package mandated by the Watershed Agreement constitutes a needed injection of market forces in the distribution of water. Water waste has been a significant problem since the days of the first Croton Dam. It is hoped that having New York City actually bear the cost of its water will induce a more responsible use of resources within the Watershed. Even with the substantial financial assistance extended by the City, the Watershed Communities bear the cost of foregone development in economically advantageous but environmentally sensitive land. Those communities have survived under the sometimes onerous burden of New York City\u27s need for clean water and should be commended for their perseverance

Boosting Health Information Technology in Medicaid: The Potential Effect of the American Recovery and Reinvestment Act

The American Recovery and Reinvestment Act of 2009 (ARRA) will invest approximately $49 billion to expedite health information technology (HIT) adoption through Medicare and Medicaid. Our analysis of 2006 NAMCS data found that approximately 15 percent of the practicing office-based physicians in the country would qualify for up to$63,750 over six years in Medicaid financial incentives for HIT adoption. Included within the 45,000 eligible physicians are about 99 percent of all community health center physicians. If all qualifying physicians apply for the Medicaid incentives and receive the maximum level of payments, the federal government would invest more than $2.8 billion in HIT

Financing Community Health Centers as Patient- and Community-Centered Medical Homes: A Primer

This policy brief is part of a Commonwealth Fund-supported project that examines community health centers in the context of the patient-centered medical home (PCMH) movement. Community health centers—non-profit primary care facilities that provide care to patients regardless of their ability to pay—are widely lauded as critical components of the health care safety net, providing comprehensive primary care for lowincome, high-risk populations in both urban and rural areas. Since their inception, health centers have directed their activities at improving patient care—through comprehensive primary health care, coordination with specialty care, and the provision of enabling services—as well as improving population-level health status and access to care. Health centers are models for the organization and delivery of health care based on the principles of community-oriented primary care, which focuses on the health of both patients and communities. National discussions of health reform often consider the potential for the patient-centered medical home model to strengthen primary care, prevent or alleviate the long-term consequences of chronic health conditions and disease, and bring greater efficiency to the health care system. A 2008 report released by Senate Finance Committee Chairman Max Baucus describes an emphasis on primary care as a common element of high-performing health systems and recommends further testing and implementation of the PCMH model. The report notes that community health centers represent a critical component of the health care safety net, and have already implemented many elements of the PCMH model. An April 2009 bipartisan policy options report released by the Senate Finance Committee also cites patient-centered medical homes as a possible way to improve care for chronic health conditions. This brief provides a summary of the patient-centered medical home concept, followed by an overview of health centers and an in-depth look at health center financing. Because further evolution toward a PCMH model depends on the realignment of health center payment incentives, it is critical to understand how financing arrangements currently operate, what types of conduct and practices may be incentivized or deterred, and the types of challenges that lie ahead as health care payment policies are reformulated over time. Some of these challenges are faced by all providers as they attempt to reconcile multiple—and potentially competing or inconsistent—incentives created by insurers. Other challenges are associated with the unique mission of health centers and their ability to align quality improvement efforts with their fundamental duty to serve all community residents, regardless of their uninsured or underinsured status