Explore the vast range of titles available.

The changing prices of bunker fuel open the door for substantial cost savings by adjusting the sailing speed of ships. A large ship may be burning up to 100 000 USD of bunker fuel per day, which may constitute more than 75% of its operating costs. Reducing the cruising speed by 20% reduces daily bunker consumption by 50%. However, in order to maintain liner service frequency and capacity, reducing the cruising speed may require additional ships to operate a route. We construct a cost model that we use to analyse the trade-off between speed reduction and adding vessels to a container line route, and devise a simple procedure to identify the sailing speed and number of vessels that minimize the annual operating cost of the route. Using published data, we demonstrate the potential for large-cost savings when one operates close to the minimal-cost speed. The presented methodology and procedure are applicable for any bunker fuel price.

This study was aimed to determine the influence of performing primary tillage by moldboard plow and planting operation by four rows Gaspardo planter on some performance and economic indicators of Armatrac tractor 854e 84 hp (62kw).  The system calculates and measures slippage percentage, draft force, energy requirements, and total costs for planting and tillage operation at three practical velocities and two depths. Planting operation performed at 5 and 7 cm depth under 2.90, 4.27, and 5.28 km.h-1. while ploughing operation performed at 15 and 20 cm tillage depth under 3.89, 5.28, and 6.67 km.h-1. Two factorial experiments were carried out using randomized complete block design with two factors and three replications. The results of analysis of variance showed that increases of practical velocity results in increase of slippage percentage and draft force but results in decrease of energy requirements and total costs. Furthermore, this study revealed that increases the depth of operation results in increase of slippage percentage, draft force, energy requirements, and total costs.

Objectives: To estimate the actual cost savings that could be achieved through reductions in intensive care unit (ICU) length of stay and duration of mechanical ventilation by determining the short-run marginal variable cost of an ICU and ventilator day. Research Design: Retrospective cohort study in a university-affiliated teaching hospital. Subjects: All patients receiving mechanical ventilation in the ICU for more than 48 hours (n = 1778) from July 1, 2005 to June 30, 2006. Measures: The hospital's administrative and cost databases were used to determine total costs, variable costs, and direct-variable costs for each patient on each individual ICU and hospital day. Results: Direct-variable costs comprised 19.3% of total ICU costs and 18.4% of total hospital costs. Marginal direct-variable costs (the cost of each additional ICU day) were small compared with the average daily total cost ($649 to $839 vs. $1751, in US dollars). In survivors with ICU lengths of stay more than 3 days, the mean direct-variable cost of the last ICU day was $397, while the mean direct-variable cost of the first ward day was $279, for a mean cost difference of $118 (95% CI, $21—$190). Reducing ICU and hospital length of stay by 1 day in all survivors with ICU lengths of stay more than 3 days would result in an immediate cost savings of only 0.2% of all hospital expenditures for these patients. Conclusions: Marginal variable ICU costs are relatively small compared with average total costs and are only slightly greater than the cost of a ward day.

We study the price adjustment practices and provide quantitative measurement of the managerial and customer costs of price adjustment using data from a large U.S. industrial manufacturer and its customers. We find that price adjustment costs are a much more complex construct than the existing industrial-organization or macroeconomics literature recognizes. In addition to physical costs (menu costs), we identify and measure three types of managerial costs (information gathering, decision-making, and communication costs) and two types of customer costs (communication and negotiation costs). We find that the managerial costs are more than 6 times, and customer costs are more than 20 times, the menu costs. In total, the price adjustment costs comprise 1.22% of the company's revenue and 20.03% of the company's net margin. We show that many components of the managerial and customer costs are convex, whereas the menu costs are not. We also document the link between price adjustment costs and price rigidity. Finally, we provide evidence of managers' fear of antagonizing customers.

BackgroundThe out-of-pocket spending and costs incurred by households affected by tuberculosis (TB) while accessing TB services in Somalia remain unclear. This study is the first of its kind in Somalia, estimating the proportion of TB-affected households that experience catastrophic costs among individuals with TB.MethodsA nationally representative, descriptive, cluster-sampled cross-sectional survey was conducted among individuals receiving TB care within the Somali National TB network from December 28, 2023, to February 3, 2024. It utilized retrospective data collection to gather information on participants’ sociodemographic and clinical characteristics, including care models, self-reported income and expenses, and the costs (out-of-pocket expenses and indirect) associated with a single episode of TB. The survey also examined risk factors for incurring these costs and mechanisms for dissaving. TB catastrophic cost is defined as the total costs (both direct and indirect) incurred during TB illness and treatment that exceed 20% of a household’s annual income.ResultsOverall, 68% (95% CI: 64%–71%) of households affected by TB in Somalia faced costs exceeding 20% of their household income. Among patients receiving first- and second-line drug treatment, the percentages were 69% (95% CI: 65%–73%) and 62% (95% CI: 52%–71%), respectively. Individuals with TB living in the Southwest states were the most likely to incur catastrophic costs associated with the disease. Self-reported monthly household income decreased by 43%, dropping from US $176 before contracting TB to US $101 during the interview. A total of 75.4% (364) of households facing TB-related catastrophic costs reported a decline in their financial situation while seeking TB services. To cope with the economic burden of TB-related catastrophic expenses, 42% (375) of individuals with TB and their households relied on one or more dis-saving strategies, such as taking out loans or selling assets.ConclusionsThis study found that almost three out of four patients in TB care and their households experience a substantive economic burden accessing TB services in Somalia, particularly during the continuation phase of their treatment, and mainly driven by the direct nonmedical costs. A sustainable and equitable social protection program is required to reduce the proportion of households facing economic burdens due to TB in Somalia.

Existing literature discusses a number of possible pioneering cost advantages and disadvantages. In this paper, we empirically test three different sources of long-term pioneering cost advantage— experience curve effects, preemption of input factors , and preemption of ideal market space —and three different sources of pioneering cost disadvantage— imitation , vintage effects , and demand orientation . We disentangle these sources by breaking total cost of a business unit into three different components—purchasing, production, and selling, general, and administrative (SG&A) costs—and identifying conditions that intensify or reduce the effect of the proposed source. Using two samples of business units, one for consumer goods and one for industrial goods, we find support for five of the six sources of pioneering cost advantage and disadvantage in both samples, while the advantage due to preemption of ideal market space is limited to the consumer goods sample. The unconditional analysis shows a pioneering purchasing cost advantage but even larger pioneering production and SG&A cost disadvantages . The complexity of our obtained findings suggests that managers need to think carefully about their particular conditions before making assumptions about the cost and, therefore, profit implications of a pioneering strategy.

We examine the heterogeneous relationship between the adoption of EMR and hospital operating costs at thousands of US hospitals between 1996 and 2009. We first document a previously-identified puzzle: Adoption of EMR is associated with a slight cost increase. Drawing on the literature on IT and productivity, we analyze why this average effect arises. We find that: (i) EMR adoption is initially associated with a rise in costs; (ii) EMR adoption at hospitals in IT-intensive locations leads to a decrease in costs after three years; and (iii) Hospitals in other locations experience an increase in costs even after six years.

Aims: To test the long term cost-benefit and cost-effectiveness of the Sherbrooke model of management of subacute occupational back pain, combining an occupational and a clinical rehabilitation intervention. Methods: A randomised trial design with four arms was used: standard care, occupational arm, clinical arm, and Sherbrooke model arm (combined occupational and clinical interventions). From the Quebec WCB perspective, a cost-benefit (amount of consequence of disease costs saved) and cost-effectiveness analysis (amount of dollars spent for each saved day on full benefits) were calculated for each experimental arm of the study, compared to standard care. Results: At the mean follow up of 6.4 years, all experimental study arms showed a trend towards cost benefit and cost effectiveness. These results were owing to a small number of very costly cases. The largest number of days saved from benefits was in the Sherbrooke model arm. Conclusions: A fully integrated disability prevention model for occupational back pain appeared to be cost beneficial for the workers’ compensation board and to save more days on benefits than usual care or partial interventions. A limited number of cases were responsible for most of the long term disability costs, in accordance with occupational back pain epidemiology. However, further studies with larger samples will be necessary to confirm these results.

Objective To provide a comprehensive state‐of‐the‐art review from the perspective of the surgeon and the surgical specialty academies of the conceptual shift from a volume‐driven fee‐for‐service payment model to one of value‐based accountable care payment. This field guide attempts to clarify drivers of surgical value‐based performance and outline a comprehensive strategy to successfully engage this healthcare reform paradigm. Data Source Pubmed/MEDLINE/Google search. Review Methods Pubmed/MEDLINE/Google search was performed during June 1, 2024–May 17, 2025 for value‐based initiatives, administrative, and government agency publications, Centers for Medicare and Medicaid Services, and Center for Medicare and Medicaid Innovation value‐based care policy, directives, and programs. Conclusions The transition from volume‐based to value‐based payment models necessitates rethinking how surgeons define, quantify, and engage the care they deliver. The social contract between the surgeon and patient is poorly aligned within the current fragmented fee‐for‐service payment model. Relative value units continue to function as a poor benchmark measure of the physician‐patient relationship, which is foundational to achieving consistent patient engagement and favorable clinical outcomes. To facilitate this value‐based realignment within surgical care, we introduce a novel three‐dimensional framework for patient experience management (EM3) focusing on three core elements driving value‐based surgical care: clinical outcomes, patient engagement, and episode‐of‐care spend. EM3 is proposed as a strategic roadmap to operationalize episode‐of‐care transparency within the traditional value equation: Value = Outcomes/Cost. EM3 lays out a comprehensive pathway to facilitate improvements in surgical value‐chain competency, team‐based care leadership, and longitudinal care management skills. These represent the essential core components for competitiveness within a new era of performance metrics relevant to alternative payment arrangements within bundle payments and value‐based referrals. At the academy and peer‐review leadership level, each surgical specialty will need to invest in developing clinically valid next generation assessment measures and care plans encompassing EM3 dimensional elements to remain both relevant and competitive in a new era of evolving accountable care models. We provide a comprehensive summary of the shift from Fee‐for‐Service to Value‐based care. We present a systems based approach (EM3) for surgeons to engage this process. The EM3 framework is a comprehensive strategy for surgeons, surgical specialty academies, and peer review societies to redesign how surgical care is delivered and measured using a value chain approach.

This paper proposes a reputation-based winner determination problem for transportation procurement auctions where the allocation of long-term contracts to carriers is decided with respect to both bid ask-prices and carriers reputation. The objective is to manage the trade-off between transport costs and the quality of service during operations. Carriers reputation is translated into unexpected hidden cost that represents the possible additional cost that the shipper may incur when dealing with a set of winning carriers. This cost depends essentially on the carriers reputation as evaluated by the shipper running the auction. To evaluate carriers reputations, the shipper uses a number of service attributes with different weights depending on shipping contracts.