public expenditure review (PER)

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Equity research - Ryanair Holding PLC

Mestrado em FinançasEquity Research sobre a Ryanair Holdings PLC (RYA), elaborado segundo as recomendações do CFA Institute, que integra a avaliação minuciosa de toda a sua atividade, com o objetivo final de se perspetivar o valor intrínseco das suas ações a 31 de Dezembro de 2020. A estrutura orgânica do presente documento é dividida em duas partes distintas: uma primeira parte, onde se analisa e se apresenta a RYA e a indústria onde se insere e uma segunda parte, onde, considerando as informações da primeira parte, se projeta e se mensura o desenvolvimento da empresa nos próximos anos, recorrendo a modelos de avaliação como o dos Fluxos de Caixa Atualizados e o Valor Atual Ajustado (métodos absolutos) e ainda ao modelo dos Múltiplos comparáveis (método relativo). Todo o conteúdo deste projeto contempla informações passíveis de análise até dia 27 de Setembro de 2019. Com um preço-alvo de €10,95, no final de 2020, calculado através do modelo dos Fluxos de Caixa Atualizados, representando um potencial de valorização de 6,37% considerando o preço de €10,29, a 27 de Setembro de 2019, a nossa recomendação de investimento é MANTER, ou seja, não se considera a existência de razões fortes para a compra, nem de razões negativas para a venda. Seguindo as especificações do modelo de Valor Atual Ajustado, alcança-se um resultado idêntico que sustenta a mesma recomendação. Com um preço-alvo de €11,10, o que totaliza um potencial de valorização de 7,90%, o conselho de MANTER, preserva-se.As part of the Master's Final Work in Finance, and according to the recommendations of the CFA Institute, this project about Ryanair Holdings PLC (RYA), which integrates the scrupulous analysis of all its business activity, has been settled with the main purpose of knowing the intrinsic value of its shares, on the 31st December, 2020. The organic structure of this project is divided into two distinct parts. The first part where RYA is analyzed and also the industry in which the Company operates; the second part, in which, the information in the first part is considered and it is forecasted and measured the Company's growth, over the next few years, using valuation models as Discounted Cash Flows (DCF), Adjusted Present Value (absolute methods) and the Multiples Approach (relative method). All of the developments of this project include information until 27th September 2019. With a target price of €10.95 at the end of 2020, given the DCF Model, representing an upside potential of 6.37% over the price of €10.29, on 27th September 2019, our investment recommendation is HOLD, that is no strong reasons for buying or selling. Considering the main features of Adjusted Present Value Model, an identical result was reached that supports the same investment recommendation. With a target price of €11.10, which adds up to a 7.90% upside potential, the advice of HOLD is well-maintained.info:eu-repo/semantics/publishedVersio

Application of the time-driven activity-based costing methodology to a complex patient case management program in Portugal

Funding Information: Hugo F. Mendonça Vitor G. Vicente Publisher Copyright: © 2023, The Author(s).Background: The number of people with chronic diseases has increased globally, as has the number of chronic diseases per person. Faced with this reality, the term “complex patient” is current and actual. The healthcare costs associated with these patients are high and are expected to increase since most healthcare systems are not yet ready to provide integrated long-term care. In Portugal, several health institutions have made efforts to provide integrated care: case management models have been implemented to complex patients follow-up. However, studies related to cost of these programs are still limited. Therefore, a qualitative investigation was conducted, approaching the design criteria of a case study research, to design a case management program for complex patients and determine its direct costs, following the Time-Driven Activity-Based Costing methodology, in Local Health Unit setting. Method: The direct costs of providing care to a complex patient involved in a case management program were determined, using the Time-Driven Activity-Based Costing methodology. A map of the complex patient was drawn, considering a standard flow in the program. Times and costs were allocated to the activities on the map, following Portuguese and international practices of case management models. Results: A total of 684,45€/year is spent for each new patient in the case management program, of which 452,65€ corresponds to cost of remuneration of professionals involved; and 663,85€/year, for each patient who is in the case management program (over 1 year), where 432,05€ corresponds to cost of the remuneration of the professionals involved. Follow-up is the most costly phase (80.82%) and where more time is spent (85.62%). Conclusion: The time spent by professionals and resources involved and the costs associated with each patient were obtained. The economic impact of the analysed activities was not studied, however, according to international authors, when well applied and selected, integrated care models lead to cost reduction and improved health outcomes.publishersversionpublishe

O financiamento hospitalar e a definição de preços

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identifying and comparing critical areas through spatial analysis

BACKGROUND: Hospitalizations for ambulatory care sensitive conditions have been used to assess the performance of primary health care. Few studies have compared geographic variation in rates of avoidable hospitalizations and characteristics of high-risk areas within and between countries. The aim of this study was to identify and compare critical areas of avoidable hospitalizations in Brazil and Portugal, because these countries have reformed their primary health care systems in recent years and have similar organizational characteristics. METHODS: An ecological study on hospitalizations for ambulatory care sensitive conditions produced in Brazil and Portugal in 2015 was used. Geographic variation of rates were analyzed and compared at the municipal level. A spatial scan statistic was employed to identify clusters with higher risk of hospitalizations for acute and chronic conditions in each country separately. Socioeconomic and primary health care characteristics of critical areas were compared to non-critical areas. RESULTS: There were high variations in rates of avoidable hospitalizations within and between Brazil and Portugal, with higher variations found in Brazil. A more evident pattern of rates was found in Portugal. Rates and cluster distribution of acute and chronic conditions had significant agreement for both countries. The differences in primary health care and socioeconomic characteristics between areas identified as high risk clusters and non-clusters varied between category of conditions and between countries. CONCLUSION: Brazil and Portugal presented expressive regional differences with respect to rates of avoidable hospitalizations, indicating that there is room to improve by reducing such events in both countries. Different areas presented distinct interactions between primary health care, socioeconomic characteristics, and avoidable hospitalizations. Results indicate that the primary health care reforms, with similar organizational characteristics in different contexts, did not produce similar results either between or within countries. Possible actions to reduce these events should be defined at a local level.publishersversionpublishe

Impact of vertical integration on frequency of hospital readmissions

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Effects of the ratio of porosity to volumetric cement content on the unconfined compressive strength of cement bound fine grained soils

This paper presents an experimental investigation into the effects of porosity, dry density and cement content on the unconfined compressive strength and modulus of elasticity of cementbound soil mixtures. A clayey sand was used with two different proportions of type IV Portland cement, 10% and 14% of the dry mass of the soil. Specimens were moulded with the same water content but using four different compaction efforts, corresponding to four different dry densities. Unconfined compression testing was conducted at seven days of curing time on unsoaked samples. The results showed that the compressive strength increased with the increase in cement content and with the decrease in porosity. From the experimental data, a unique relationship was found between the unconfined compressive strength and the ratio of porosity to volumetric cement content for all the mixtures and compaction efforts tested. The equation developed demonstrates that it is possible to estimate the amount of cement and the dry density to achieve a certain level of unconfined compressive strength. A normalized general equation was also found to fit other authors’ results for similar soils mixed with cement. From this, a cement-bound soil model was proposed for the development of a mixing design procedure for different soils.publishersversionpublishe

an ecological study in Portugal

Funding Information: The present publication was funded by Fundação Ciênciae Tecnologia, IP national support through CHRC (UIDP/04923/2020) and NOVA National School of Public Health. Publisher Copyright: © 2021, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.Background: Hospitalisations for Ambulatory Care Sensitive Conditions (ACSC) cause harm to users and to health systems, as these events are potentially avoidable. In 2009, Portugal was hit by an economic and financial crisis and in 2011 it resorted to foreign assistance (“Memorandum of Understanding” (2011–2014)). The aim of this study was to analyse the association between the Troika intervention and hospitalisations for ACSC. Methods: We analysed inpatient data of all public NHS hospitals of mainland Portugal from 2007 to 2016, and identified hospitalisations for ACSC (pneumonia, chronic obstructive pulmonary disease, hearth failure, hypertensive heart disease, urinary tract infections, diabetes), according to the AHRQ methodology. Rates of hospitalisations for ACSC, the rate of enrollment in the employment center and average monthly earnings were compared among the pre-crisis, crisis and post-crisis periods to see if there were differences. A Spearman’s correlation between socioeconomic variables and hospitalisations was performed. Results: Among 8,160,762 admissions, 892,759 (10.94%) were classified as ACSC hospitalizations, for which 40% corresponded to pneumonia. The rates of total hospitalisations and hospitalisations for ACSC increased between 2007 and 2016, with the central and northern regions of the country presenting the highest rates. No correlations between socioeconomic variables and hospitalisation rates were found. Conclusions: During the period of economic and financial crisis based on Troika’s intervention, there was an increase in potentially preventable hospitalisations in Portugal, with disparities between the municipalities. The high use of resources from ACSC hospitalisations and the consequences of the measures taken during the crisis are factors that health management must take into account.publishersversionpublishe

what conditions make inter-country comparisons possible?

Hospitalizations for ambulatory care sensitive conditions have been extensively used in health services research to assess access, quality and performance of primary health care. Inter-country comparisons can assist policy-makers in pursuing better health outcomes by contrasting policy design, implementation and evaluation. The objective of this study is to identify the conceptual, methodological, contextual and policy dimensions and factors that need to be accounted for when comparing these types of hospitalizations across countries. A conceptual framework for inter-country comparisons was drawn based on a review of 18 studies with inter-country comparison of ambulatory care sensitive conditions hospitalizations. The dimensions include methodological choices; population's demographic, epidemiologic and socio-economic profiles and features of the health services and system. Main factors include access and quality of primary health care, availability of health workforce and health facilities, health interventions and inequalities. The proposed framework can assist in designing studies and interpreting findings of inter-country comparisons of ambulatory care sensitive conditions hospitalizations, accelerating learning and progress towards universal health coverage.publishersversionpublishe