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PubMed1991

Use and impact of a cash subsidy program.

The use and impact of a $256.74 monthly cash subsidy by 1,283 families with children who have severe disabilities were examined. Families reported a variety of uses, including the purchase of clothing, toys, sitters, diapers, special foods, adaptive equipment, and professional services. Families at lower income levels used the subsidy to meet basic needs more often than did families at higher income levels. Families indicated that the subsidy was very helpful in meeting special needs and had improved family life, eased financial worries, and reduced stress. The influence of the availability of the subsidy on continuing family-based care was examined.

Adolescent↗

PubMed1994

Assessment for rest home subsidy: are the elderly getting a fair deal?

AIM: To describe the role of a geriatric service in assessing the needs of elderly people at home or in rest homes referred for a subsidy for rest home care, and to compare this assessment with the composite dependency scale (CDS), a Department of Social Welfare assessment instrument. METHODS: A 47 item questionnaire was completed by the geriatric service at the time of assessment of elderly people in the community or in rest homes. RESULTS: Of 280 assessments, 100 were from private homes, 180 from rest homes. Sixty-three per cent in rest homes were referred only because private funds were exhausted, 33% for a change in dependency category. These two groups plus those at home were used as a basis for comparison in subsequent analysis. Of those at home: 30% already had a rest home bed arranged; 77% remembered being consulted about rest home care, but only 38% were sure they wanted to go into such care. The proportion of those too independent or too sick for rest home care was: private homes 14%, rest home resident requiring subsidy 6%, rest home requiring change in category status 11%. Twenty three percent of those at home could continue there with or without additional support. No significant difference was found in dependency between those in rest homes only seeking funding, and those at home, but both of these groups were significantly less dependent than those seeking an increase in subsidy. There was only a moderate correlation (rs = 0.778) between the geriatric service assessment of dependency and the composite dependency score. CONCLUSIONS: Many elderly people do not feel properly consulted about rest home placement, and some could be supported at home for longer. It is likely that many who can afford rest home fees are entering too early and then asking for a subsidy when their funds are exhausted. By then it is almost impossible to insist on alternatives in the community. A policy of geriatric service assessment for all seeking entry into rest home care should ensure independent consultation and consideration of alternative strategies. More research is required to examine cost implications of unrestricted movement into rest homes.

Aged↗

PubMed2001

The cost-effectiveness of public postsecondary education subsidies.

BACKGROUND: Although educational attainment is a well-recognized covariate of health status, it is rarely thought of as a tool to be used to improve health. Since fewer than 40% of U.S. citizens have a college degree, it may be possible for the government to improve the health status of the population by assuming a larger burden of the cost of postsecondary education. This paper examines the costs and health effects of a government subsidy for public postsecondary education institutions. METHODS: All high school graduates in 1997 were included in a decision analysis model as a hypothetical cohort. Data from the U.S. Department of Education, the World Health Organization, and the National Center for Health Statistics were used as model inputs. Results. Relative to the present educational system, a federal subsidy for public and private colleges equal to the amount now paid by students for tuition and living expenses would save $6,176 and avert 0.0018 of a disability-adjusted life-year (DALY) per person annually if enrollment increased 5%. The overall savings among 1997 high school graduates would be $17.1 billion and 4,992 DALYs would be averted per year relative to the present educational system. If enrollment increased by just 3%, $3,743 would be saved and 0.0011 DALYs would be averted per person. An enrollment increase of 7% would lead to savings of $8,610 and 0.0025 DALYs would be averted per person relative to the present educational system. CONCLUSIONS: If the government were to offer a full subsidy for college tuition at public universities, both lives and money would be saved, so long as enrollment levels increased. Providing a free postsecondary education for students attending public schools may be more cost-effective than most health investments.

Adolescent↗

PubMed2006

Stream communities along a catchment land-use gradient: subsidy-stress responses to pastoral development.

When native grassland catchments are converted to pasture, the main effects on stream physicochemistry are usually related to increased nutrient concentrations and fine-sediment input. We predicted that increasing nutrient concentrations would produce a subsidy-stress response (where several ecological metrics first increase and then decrease at higher concentrations) and that increasing sediment cover of the streambed would produce a linear decline in stream health. We predicted that the net effect of agricultural development, estimated as percentage pastoral land cover, would have a nonlinear subsidy-stress or threshold pattern. In our suite of 21 New Zealand streams, epilithic algal biomass and invertebrate density and biomass were higher in catchments with a higher proportion of pastoral land cover, responding mainly to increased nutrient concentration. Invertebrate species richness had a linear, negative relationship with fine-sediment cover but was unrelated to nutrients or pastoral land cover. In accord with our predictions, several invertebrate stream health metrics (Ephemeroptera-Plecoptera-Trichoptera density and richness, New Zealand Macroinvertebrate Community Index, and percent abundance of noninsect taxa) had nonlinear relationships with pastoral land cover and nutrients. Most invertebrate health metrics usually had linear negative relationships with fine-sediment cover. In this region, stream health, as indicated by macroinvertebrates, primarily followed a subsidy-stress pattern with increasing pastoral development; management of these streams should focus on limiting development beyond the point where negative effects are seen.

Animals↗

PubMed2003

Experimental evidence that terrestrial carbon subsidies increase CO2 flux from lake ecosystems.

Subsidies are donor-controlled inputs of nutrients and energy that can affect ecosystem-level processes in a recipient environment. Lake ecosystems receive large inputs of terrestrial carbon (C) in the form of dissolved organic matter (DOM). DOM inputs may energetically subsidize heterotrophic bacteria and determine whether lakes function as sources or sinks of atmospheric CO(2). I experimentally tested this hypothesis using a series of mesocosm experiments in New England lakes. In the first experiment, I observed that CO(2) flux increased by 160% 4 days following a 1,000 microM C addition in the form of DOM. However, this response was relatively short lived, as there was no effect of DOM enrichment on CO(2) flux beyond 8 days. In a second experiment, I demonstrated that peak CO(2) flux from mesocosms in two lakes increased linearly over a broad DOM gradient (slope for both lakes=0.02+/-0.001 mM CO(2).m(-2) day(-1) per microM DOC, mean+/-SE). Concomitant changes in bacterial productivity and dissolved oxygen strengthen the inference that increasing CO(2) flux resulted from the metabolism of DOM. I conducted two additional studies to test whether DOM-correlated attributes were responsible for the observed change in plankton metabolism along the subsidy gradient. First, terrestrial DOM reduced light transmittance, but experimental shading revealed that this was not responsible for the observed patterns of CO(2) flux. Second, organically bound nitrogen (N) and phosphorus (P) accompanied DOM inputs, but experimental nutrient additions (without organic C) caused mesocosms to be saturated with CO(2). Together, these results suggest that C content of terrestrial DOM may be an important subsidy for freshwater bacteria that can influence whether recipient aquatic ecosystems are sources or sinks of atmospheric CO(2).

Carbon↗

PubMed2002

The effects of drug subsidies on out-of-pocket prescription drug expenditures by seniors: regional evidence from Canada.

Between 1970 and 1986, all Canadian provinces introduced some version of a prescription drug subsidy for those aged 65 years or over and since 1986, all the provinces have increased copayments or deductibles to some degree. Employing a first-order approximation to the welfare gains from a subsidy, we find evidence that these subsidies have been less redistributive than an absolute per household cash transfer but slightly more redistributive than a transfer that would increase each household's income by the same percentage. Such evidence may have relevance for predicting the redistributive effects of a potential national prescription drug plan for seniors in the US.

Aged↗

PubMed2004

Developing the formula for state subsidies for health care in Finland.

AIM: The aim was to generate a research-based proposal for a new subsidy formula for municipal healthcare services in Finland. METHODS: Small-area data on potential need variables, supply of and access to services, and age-, sex- and case-mix-standardised service utilisation per capita were used. Utilisation was regressed in order to identify need variables and the cost weights for the selected need variables were subsequently derived using various multilevel models and structural equation methods. RESULTS: The variables selected for the subsidy formula were as follows: age- and sex-standardised mortality (age under 65 years) and income for outpatient primary health services; age- and sex-standardised mortality (all ages) and index of overcrowded housing for elderly care and long-term inpatient care; index of disability pensions for those aged 15-55 years and migration for specialised non-psychiatric care; and index of living alone and income for psychiatric care. CONCLUSION: Decisions on the amount of state subsidies can be divided into three stages, of which the first two are mainly political and the third is based on the results of this study.

Adolescent↗

PubMed2004

Subsidies and the demand for individual health insurance in California.

OBJECTIVE: To estimate the effect of changes in premiums for individual insurance on decisions to purchase individual insurance and how this price response varies among subgroups of the population. DATA SOURCE: Survey responses from the Current Population Survey (http://www.bls.census.gov/cps/cpsmain.htm), the Survey of Income and Program Participation (http://www.sipp.census.gov/sipp), the National Health Interview Survey (http://www.cdc.gov/nchs/nhis.htm), and data about premiums and plans offered in the individual insurance market in California, 1996-2001. STUDY DESIGN: A logit model was used to estimate the decisions to purchase individual insurance by families without access to group insurance. This was modeled as a function of premiums, controlling for family characteristics and other characteristics of the market. A multinomial model was used to estimate the choice between group coverage, individual coverage, and remaining uninsured for workers offered group coverage as a function of premiums for individual insurance and out-of-pocket costs of group coverage. PRINCIPAL FINDINGS: The elasticity of demand for individual insurance by those without access to group insurance is about -.2 to -.4, as has been found in earlier studies. However, there are substantial differences in price responses among subgroups with low-income, young, and self-employed families showing the greatest response. Among workers offered group insurance, a decrease in individual premiums has very small effects on the choice to purchase individual coverage versus group coverage. CONCLUSIONS: Subsidy programs may make insurance more affordable for some families, but even sizeable subsidies are unlikely to solve the problem of the uninsured. We do not find evidence that subsidies to individual insurance will produce an unraveling of the employer-based health insurance system.

Adult↗

PubMed2006

Nutrient subsidies to belowground microbes impact aboveground food web interactions.

Historically, terrestrial food web theory has been compartmentalized into interactions among aboveground or belowground communities. In this study we took a more synthetic approach to understanding food web interactions by simultaneously examining four trophic levels and investigating how nutrient (nitrogen and carbon) and detrital subsidies impact the ability of the belowground microbial community to alter the abundance of aboveground arthropods (herbivores and predators) associated with the intertidal cord grass Spartina alterniflora. We manipulated carbon, nitrogen, and detrital resources in a field experiment and measured decomposition rate, soil nitrogen pools, plant biomass and quality, herbivore density, and arthropod predator abundance. Because carbon subsidies impact plant growth only indirectly (microbial pathways), whereas nitrogen additions both directly (plant uptake) and indirectly (microbial pathways) impact plant primary productivity, we were able to assess the effect of both belowground soil microbes and nutrient availability on aboveground herbivores and their predators. Herbivore density in the field was suppressed by carbon supplements. Carbon addition altered soil microbial dynamics (net potential ammonification, litter decomposition rate, DON [dissolved organic N] concentration), which limited inorganic soil nitrogen availability and reduced plant size as well as predator abundance. Nitrogen addition enhanced herbivore density by increasing plant size and quality directly by increasing inorganic soil nitrogen pools, and indirectly by enhancing microbial nitrification. Detritus adversely affected aboveground herbivores mainly by promoting predator aggregation. To date, the effects of carbon and nitrogen subsidies on salt marshes have been examined as isolated effects on either the aboveground or the belowground community. Our results emphasize the importance of directly addressing the soil microbial community as a factor that influences aboveground food web structure by affecting plant size and aboveground plant nitrogen.

Animals↗

PubMed2002

Participation in a public insurance program: subsidies, crowd-out, and adverse selection.

This paper examines how varying the level of subsidies affects participation in a public insurance program, crowd-out of private insurance, and adverse selection. We study the experience in Washington's Basic Health program in 1997. Findings show that adverse selection is not a problem in voluntary public programs. Increasing subsidies have only modest effects on participation in subsidized programs, though the gains are not at the expense of the private market. Overall participation in the subsidized plan is also modest, even though participants benefit from it. The challenge to policymakers is to find program design characteristics, beyond subsidies, that attract the uninsured.

Adolescent↗

PubMed1989

Impact of a cash subsidy program for families of children with severe developmental disabilities.

The impact of a cash subsidy program on 81 families raising children with severe handicaps was examined. Families were interviewed prior to receiving the $225 monthly subsidy and one year later. Mothers reported significantly less family stress, particularly related to financial stress, and enhanced life satisfaction. Furthermore, they were less likely to anticipate out-of-home placement for their child after receiving the subsidy. In general, lower income and black mothers were less likely to plan placement. However, the number of families stating that they planned placement was too small to allow us to fully explore the interrelations between out-of-home placement and various social, cultural, and economic factors.

Adolescent↗

PubMed1994

Cash subsidy program: family satisfaction and need.

Families of children with severe developmental disabilities who were participating in a cash subsidy program were surveyed about their satisfaction with the program. They were also asked about their need for a variety of other services. Families were satisfied with the operation of the program and with the amount of the subsidy they received. Families indicated a need for more respite care or sitters more often than any other service. Respondents were found to use their subsidy for the types of services they said they needed.

Aid to Families with Dependent Children↗

PubMed2006

Identification and quantification of subsidies relevant to the production of local and imported pig breeds in Vietnam.

Livestock diversity contributes in many ways to human survival and well-being, while its loss reduces options for attaining sustainable agriculture and universal food security. The current rapid rate of loss of this diversity is the result of a number of underlying factors. While in some cases changes in production systems and consumer preferences reflect the natural evolution of developing economies and markets, in other cases production systems, breed choice and consumer preferences have been distorted by local, national and international policy. In the context of a widespread threat to local pig breeds in Vietnam, this paper identifies and quantifies the level of agricultural subsidies that are currently contributing to this process of breed substitution. Producer subsidies-which tend to improve the competitiveness of imported breeds and their crosses over local breeds--are shown to be considerable, and mitigating measures are now urgently needed to avoid an irreversible loss of livestock diversity.

Animal Husbandry↗

PubMedDate not supplied

The impact of the new subsidy regime in general practice in New Zealand.

The first substantial change in the New Zealand health care reforms was the introduction in February 1992 of a new subsidy and charging regime in general practice. The paper reports on a comparison of data collected before and after the changes, drawing on GP-patient encounter information. Overall, seasonally adjusted levels of utilisation were maintained in the stage before the introduction of the new regime, declined 15% immediately following the changeover and stabilised thereafter. All patient groups were affected by the decline. Although the elderly were temporarily exempt from the changes, their consultations fell by 10%. Utilisation among beneficiaries--minor gainers from the changes--dropped by 30%. Children were more affected overall, adults less so. There was also some suggestion of greater falls for the lowest socio-economic groups. Activities under the direct control of the practitioner--prescribing and the ordering of tests--showed either little turbulence or no clear pattern of change. It is concluded that, although primary care subsidies and charges had been reshaped to favour poorer people, six months after the introduction of these changes there had been no corresponding redistribution of medical care consumed. Indeed, there is a suggestion that some of the groups ostensibly the target of increased assistance may have been adversely affected by the overall decline in utilisation.

Attitude to Health↗

PubMed2005

The effect of a subsidy policy on the utilization of community care services under a public long-term care insurance program in rural Japan.

This cross-sectional study investigated the effect of an interim subsidy policy for low-income beneficiaries to buy home help services under Japanese long-term care insurance (LTCI) for the service utilization of home help and other community care services. Claims records during the period from October to December 2001 were reviewed to compare the monthly amounts for each service and out-of-pocket copayment for subsidized (n = 137) and non-subsidized (n = 124) beneficiaries. A multivariable linear regression analysis was conducted to control for age, gender, household size, length of care, and care eligibility level. Compared with the non-subsidized beneficiaries, the subsidized beneficiaries used 1.53 times as much home help service (p < 0.001), and spent 0.70 times as much on out-of-pocket copayments (p < 0.001), while they used fewer adult daycare services (0.71 times as much as the non-subsidized did, p = 0.063). The results strongly indicated that the interim subsidy for low-income beneficiaries alleviated the economic burden, but also resulted in service overuse and the substitution of home help services for other community care services. The policy implications of these findings were discussed.

Aged↗

PubMed2004

Subsidies to employee health insurance premiums and the health insurance market.

One approach to covering the uninsured that is frequently advocated by policy-makers is subsidizing the employee portion of employer-provided health insurance premiums. But, since the vast majority of those offered employer-provided health insurance already take it up, such an approach is only appealing if there is a very high takeup elasticity among those who are offered and uninsured. Moreover, if plan choice decisions are price elastic, then such subsidies can at the same time increase health care costs by inducing selection of more expensive plans. We study an excellent example of such subsidies: the introduction of pre-tax premiums for postal employees in 1994, and then for the remaining federal employees in 2000. We do so using a census of personnel records for all federal employees from 1991 through 2002. We find that there is a very small elasticity of insurance takeup with respect to its after-tax price, and a modest elasticity of plan choice. Our results suggest that the federal government did little to improve insurance coverage, but much to increase health care expenditures, through this policy change.

Employer Health Costs↗

PubMed2005

Comparing the welfare effects of public and private health care subsidies in the United Kingdom.

We use a calibrated analytical model to compare the welfare costs (gross of externalities) of increasing subsidies for public and private health care in the UK. The model incorporates wait costs for rationed public care, burdens that subsidies impose on the tax system, and distributional weights for different households. Welfare costs are significantly higher for expanding public health care over a range of parameter scenarios. Both policies reduce average wait times, but for public health care this is offset by new waiting costs incurred on extra treatments. And the burden on the tax system is much larger for expanding public health care.

Delivery of Health Care↗

PubMed2005

Policy evaluation for the subsidy for influenza vaccination in elderly.

OBJECTIVE: In Japan, the subsidy of influenza vaccination for the elderly was introduced in November 2001. This paper examines its policy evaluation from the viewpoint of cost-benefit analysis. MATERIALS: The data of copayment of influenza vaccination, population and shot rate of the elderly are surveyed by telephone interview to the correspondents in the local governments of Tokyo metropolitan and other 12 big cities in Japan. The mortality due to pneumonia or influenza is obtained from Vital Statistics of Population. METHOD: At first, I examine the impact of amount of copayment, through its effect on shot rate, on the percentage of elderly receiving influenza vaccinations. Using these estimation results, benefit-cost ratio (BCR) is calculated. RESULTS: The estimated coefficient of copayment on shot rate is -0.007 and statistically significant. Shot rate significantly reduces pneumonia and influenza mortality and its magnitude is -0.0028. The obtained net benefit (NB) is 134.9 million yen or US$1.08 billion and benefit-cost ratio is 22.9 and its 95% confidence interval is [2.2, 43.7]. DISCUSSION: If copayment would be cut by a 1000 yen (US$8), it could avoid about 400 deaths in average big city. The benefit-cost ratio is quite high compared with the other countries or other vaccinations. CONCLUSION: We found the strong evidence in a sense of cost-benefit analysis in the subsidy for influenza vaccination in the elderly.

Aged↗