The effects of education on farmer productivity in rural Ethiopia

The Ethiopian education system is characterised by extremely low participation rates, particularly in rural areas. This paper challenges the hypothesis that demand for schooling in rural Ethiopia is constrained by the traditional nature of farm technology and lack of visible benefits of schooling in terms of farmer productivity. The effects of schooling upon farmer productivity and efficiency are examined employing both average production functions and two-stage stochastic frontier production functions. Data drawn from a large household survey conducted in 1994 were used to estimate internal and external benefits of schooling in 14 cerealproducing villages. Empirical analyses reveal substantial internal (private) benefits of schooling for farmer productivity, particularly in terms of efficiency gains. However, a threshold effect is identified: at least four years of primary schooling are required to have a significant effect upon farm productivity. Evidence of strong external (social) benefits of schooling was also uncovered, suggesting that there may be considerable opportunities to take advantage of external benefits of schooling in terms of increased farm productivity if school enrolments in rural areas are increased.

Education externalities in rural Ethiopia: evidence from average and stochastic frontier production functions.

Education will have externality effects in agriculture if, in the course of conducting their own private economic activities, educated farmers raise the productivity of uneducated farmers with whom they come into contact. This paper seeks to determine the potential size and source of such benefits for rural areas of Ethiopia. Average and stochastic frontier production function methodologies are employed to measure productivity and efficiency of farmers. In each case, internal and external returns to schooling are compared. We find that there are substantial and significant externality benefits of education in terms of higher average farm output and a shifting outwards of the production frontier. External benefits of schooling may be several times as high as internal benefits in this regard. However, we are unable to find any evidence of externality benefits to schooling in terms of improvements in technological efficiency in the use of a given technology. This suggests that the source of externalities to schooling is in the adoption and spread of innovations, which shift out the production frontier.

Concealed preferences: parental attitudes to education and enrolment choice in rural Ethiopia.

Parental attitudes regarding the value of education may determine whether some, none or all school-aged children in a household are enrolled and how much formal education they will eventually complete. To the extent that attitudes are important and can be adequately measured, they should explain household demand for schooling in the absence of constraints. However, the attitudes which people express may be inconsistent with their behaviour when faced with schooling choices for their own children. If attitudes do not explain actual enrolment, the causes of the discrepancy must be addressed. This paper attempts to measure attitudes, explain their formation and investigate the role of attitudes in the allocation of human capital. Parental attitudes toward schooling are generally to be favourable, and differences in attitudes help explain household enrolment decisions. However, attitudes alone cannot account for low enrolment in rural Ethiopia. High direct and opportunity costs of schooling also limit school participation in the face of credit constraints.

Healthcare costs and utilization for Medicare beneficiaries with Alzheimer\u27s

BACKGROUND: Alzheimer\u27s disease (AD) is a neurodegenerative disorder incurring significant social and economic costs. This study uses a US administrative claims database to evaluate the effect of AD on direct healthcare costs and utilization, and to identify the most common reasons for AD patients\u27 emergency room (ER) visits and inpatient admissions. METHODS: Demographically matched cohorts age 65 and over with comprehensive medical and pharmacy claims from the 2003-2004 MEDSTAT MarketScan Medicare Supplemental and Coordination of Benefits (COB) Database were examined: 1) 25,109 individuals with an AD diagnosis or a filled prescription for an exclusively AD treatment; and 2) 75,327 matched controls. Illness burden for each person was measured using Diagnostic Cost Groups (DCGs), a comprehensive morbidity assessment system. Cost distributions and reasons for ER visits and inpatient admissions in 2004 were compared for both cohorts. Regression was used to quantify the marginal contribution of AD to health care costs and utilization, and the most common reasons for ER and inpatient admissions, using DCGs to control for overall illness burden. RESULTS: Compared with controls, the AD cohort had more co-morbid medical conditions, higher overall illness burden, and higher but less variable costs ($13,936 s.$10,369; Coefficient of variation = 181 vs. 324). Significant excess utilization was attributed to AD for inpatient services, pharmacy, ER visits, and home health care (all p \u3c 0.05). In particular, AD patients were far more likely to be hospitalized for infections, pneumonia and falls (hip fracture, syncope, collapse). CONCLUSION: Patients with AD have significantly more co-morbid medical conditions and higher healthcare costs and utilization than demographically-matched Medicare beneficiaries. Even after adjusting for differences in co-morbidity, AD patients incur excess ER visits and inpatient admissions

Disparities in routine breast cancer screening for medicaid managed care members with a work-limiting disability

Objective: Examine disparities in routine mammography for women who qualify for Medicaid, because of a work-limiting disability. Methods: Individual-level data were obtained for women enrolled in Massachusetts Medicaid Managed Care plans who met the 2007 Healthcare Effectiveness Data and Information Set (HEDIS) criteria for the breast cancer screening measure (n=35,171). Disability status was determined from Medicaid eligibility records. Mammography screening was modeled using multivariate logistic regression. Separate models for women with and without a disability were also estimated. Results: Although unadjusted breast cancer screening rates were roughly equal for women with and without disability, after adjusting for confounders disability status had a significant negative association with screening mammography (OR=0.74; p Conclusion: Nationwide, rates of routine mammography for Medicaid managed care plans averaged below 50% in 2006. Given that a majority of eligible women served by Medicaid have disabilities, and studies have shown that women with disabilities are more likely to be diagnosed with late stage disease, a focus on improving rates of screening for women with disabilities is overdue

Persistent postoperative pain and healthcare costs associated with instrumented and non-instrumented spinal surgery: a case-control study

Purpose: To compare rates of persistent postoperative pain (PPP) after lumbar spine surgery—commonly known as Failed Back Surgery Syndrome—and healthcare costs for instrumented lumbar spinal fusion versus decompression/discectomy. Methods: The UK population-based healthcare data from the Hospital Episode Statistics (HES) database from NHS Digital and the Clinical Practice Research Datalink (CPRD) were queried to identify patients with PPP following lumbar spinal surgery. Rates of PPP were calculated by type of surgery (instrumented and non-instrumented). Total healthcare costs associated with the surgery and covering the 24-month period after index hospital discharge were estimated using standard methods for classifying health care encounters into major categories of health care resource utilization (i.e., inpatient hospital stays, outpatient clinic visits, accident and emergency attendances, primary care encounters, and medications prescribed in primary care) and applying the appropriate unit costs (expressed in 2013 GBP). Results: Increasing the complexity of surgery with instrumentation was not associated with an increased rate of PPP. However, 2-year healthcare costs following discharge after surgery are significantly higher among patients who underwent instrumented surgery compared with decompression/discectomy. Conclusions: Although there is a not insubstantial risk of ongoing pain following spine surgery, with 1-in-5 patients experiencing PPP within 2 years of surgery, the underlying indications for surgical modality and related choice of surgical procedure do not, by itself, appear to be a driving factor

The incidence and healthcare costs of persistent post-operative pain following lumbar spine surgery in the United Kingdom: a cohort study using the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) : a cohort study using the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES)

OBJECTIVE: To characterise incidence and healthcare costs associated with persistent postoperative pain (PPP) following lumbar surgery. DESIGN: Retrospective, population-based cohort study. SETTING: Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) databases. PARTICIPANTS: Population-based cohort of 10 216 adults who underwent lumbar surgery in England from 1997/1998 through 2011/2012 and had at least 1 year of presurgery data and 2 years of postoperative follow-up data in the linked CPRD-HES. PRIMARY AND SECONDARY OUTCOMES MEASURES: Incidence and total healthcare costs over 2, 5 and 10 years attributable to persistent PPP following initial lumbar surgery. RESULTS: The rate of individuals undergoing lumbar surgery in the CPRD-HES linked data doubled over the 15-year study period, fiscal years 1997/1998 to 2011/2012, from 2.5 to 4.9 per 10 000 adults. Over the most recent 5-year period (2007/2008 to 2011/2012), on average 20.8% (95% CI 19.7% to 21.9%) of lumbar surgery patients met criteria for PPP. Rates of healthcare usage were significantly higher for patients with PPP across all types of care. Over 2 years following initial spine surgery, the mean cost difference between patients with and without PPP was £5383 (95% CI £4872 to £5916). Over 5 and 10 years following initial spine surgery, the mean cost difference between patients with and without PPP increased to £10 195 (95% CI £8726 to £11 669) and £14 318 (95% CI £8386 to £19 771), respectively. Extrapolated to the UK population, we estimate that nearly 5000 adults experience PPP after spine surgery annually, with each new cohort costing the UK National Health Service in excess of £70 million over the first 10 years alone. CONCLUSIONS: Persistent pain affects more than one-in-five lumbar surgery patients and accounts for substantial long-term healthcare costs. There is a need for formal, evidence-based guidelines for a coherent, coordinated management strategy for patients with continuing pain after lumbar surgery

Health-care utilization and costs in adults with systemic lupus erythematosus in the United Kingdom: a real-world observational retrospective cohort analysis

Abstract Objective The aim was to describe direct health-care costs for adults with SLE in the UK over time and by disease severity and encounter type. Methods Patients aged ≥18 years with SLE were identified using the linked Clinical Practice Research Datalink–Hospital Episode Statistics database from January 2005 to December 2017. Patients were classified as having mild, moderate or severe disease using an adapted claims-based algorithm based on prescriptions and co-morbid conditions. We estimated all-cause health-care costs and incremental costs associated with each year of follow-up compared with a baseline year, adjusting for age, sex, disease severity and co-morbid conditions (2017 UK pounds). Results We identified 802 patients; 369 (46.0%) with mild, 345 (43.0%) moderate and 88 (11.0%) severe disease. The mean all-cause cost increased in the 3 years before diagnosis, peaked in the first year after diagnosis and remained high. The adjusted total mean annual increase in costs per patient was £4476 (95% CI: £3809, £5143) greater in the year of diagnosis compared with the baseline year (P &amp;lt; 0.0001). The increase in costs per year was 4.7- and 1.6-fold higher among patients with severe SLE compared with those with mild and moderate SLE, respectively. Primary care utilization was the leading component of costs during the first year after diagnosis. Conclusion The health-care costs for patients with SLE in the UK are substantial, remain high after diagnosis and increase with increasing severity. Future research should assess whether earlier diagnosis and treatment might reduce disease severity and associated high health-care costs. </jats:sec

Disease severity, flares and treatment patterns in adults with systemic lupus erythematosus in the UK: a real-world observational retrospective cohort analysis

Objectives The aim was to characterize disease severity, clinical manifestations, treatment patterns and flares in a longitudinal cohort of adults with SLE in the UK. Methods Adults with SLE were identified in the Clinical Practice Research Datalink–Hospital Episode Statistics database (1 January 2005–31 December 2017). Patients were required to have ≥12 months of data before and after the index date (earliest SLE diagnosis date available). SLE disease severity and flares were classified using adapted claims-based algorithms, which are based on SLE-related conditions, medications and health-service use. Results Of 802 patients, 369 had mild, 345 moderate and 88 severe SLE at baseline. A total of 692 initiated treatment in the first year after diagnosis. Five hundred and fifty-seven received antimalarials, 203 immunosuppressants and 416 oral CSs. Information on biologic use in hospitals was unavailable. The mean (S.d.) time to initiating any medication was 177 (385.3) days. The median time to first flare was 63 days (95% CI: 57, 71). At least one flare was experienced by 750 of 802 patients during follow-up; the first flare was mild for 549 of 750, moderate for 116 of 750 and severe for 85 of 750. The mean (S.d.) annual overall flare rate (year 1) was 3.5 (2.5). A shorter median time to first flare was significantly associated with moderate/severe disease (P &amp;lt; 0.001) and clinical manifestations (P &amp;lt; 0.001). Conclusion Our findings suggest some delay in the initiation of SLE treatment. Most patients experience a flare within 2 months of diagnosis. Early treatment might delay or reduce the severity of the first SLE flare and might translate to slower disease progression, lower accrual of organ damage and better outcomes

Healthcare costs and utilization for Medicare beneficiaries with Alzheimer's

<p>Abstract</p> <p>Background</p> <p>Alzheimer's disease (AD) is a neurodegenerative disorder incurring significant social and economic costs. This study uses a US administrative claims database to evaluate the effect of AD on direct healthcare costs and utilization, and to identify the most common reasons for AD patients' emergency room (ER) visits and inpatient admissions.</p> <p>Methods</p> <p>Demographically matched cohorts age 65 and over with comprehensive medical and pharmacy claims from the 2003–2004 MEDSTAT MarketScan^®Medicare Supplemental and Coordination of Benefits (COB) Database were examined: 1) 25,109 individuals with an AD diagnosis or a filled prescription for an exclusively AD treatment; and 2) 75,327 matched controls. Illness burden for each person was measured using Diagnostic Cost Groups (DCGs), a comprehensive morbidity assessment system. Cost distributions and reasons for ER visits and inpatient admissions in 2004 were compared for both cohorts. Regression was used to quantify the marginal contribution of AD to health care costs and utilization, and the most common reasons for ER and inpatient admissions, using DCGs to control for overall illness burden.</p> <p>Results</p> <p>Compared with controls, the AD cohort had more co-morbid medical conditions, higher overall illness burden, and higher but less variable costs ($13,936 s.$10,369; Coefficient of variation = 181 vs. 324). Significant excess utilization was attributed to AD for inpatient services, pharmacy, ER visits, and home health care (all p < 0.05). In particular, AD patients were far more likely to be hospitalized for infections, pneumonia and falls (hip fracture, syncope, collapse).</p> <p>Conclusion</p> <p>Patients with AD have significantly more co-morbid medical conditions and higher healthcare costs and utilization than demographically-matched Medicare beneficiaries. Even after adjusting for differences in co-morbidity, AD patients incur excess ER visits and inpatient admissions.</p