Risk/benefit, cost containment

In the 1970s and 1980s in the USA, the need for health cost containment and the alarming empirical estimates on the extent of moral hazard advised an increase in the co-payment rate for health services. Thus, Feldstein5 estimated that if the co-insurance rate were raised from 33 per cent to 67 per cent, the costs incurred due to welfare loss would fall much more than the benefits derived from reducing the risk. Subsequently, Feldman and Dowd,6 using data from the Rand experiment in the 1980s, reached similar conclusions. 

When is it permissible to deny some benefits, or put some subjects at risk, for the sake of research and the benefits it promises For example, when is it permissible to perform cost-containment research, and what type of peer review and informed consent is necessary ° This is particularly relevant for pharmacists because many are involved in this type of data collection and analysis. It is possible that some subjects may receive a lower standard of care than that to which they are accustomed. Thus, experimental strategies that reduce services may expose subjects to the possibility of harm without benefit. 

Containment uses a physical barrier to prevent an uncontrolled release of materials to the environment. The walls of a vessel or pipe serve as the primary containment barrier that encloses harmful materials. Redundant (secondary) containment serves as a safeguard if the primary barrier fails, and is considered a postrelease mitigation measure. Containment can take many forms, depending on factors such as the system or process to be contained, the risks involved with a release, and the cost benefit of the additional secondary containment. 

Currently, any substance or preparation that gives rise to concern can be reviewed. Risk assessments and adequate analysis of the cost and benefits are required prior to any proposal or adoption of a regulatory measure controlling the chemicals or preparations containing them. If considered necessary, restrictions are applied under the Marketing and Use Directive [ 5 ]. This present system works well for the new substances but is weak in regard to the existing substances. 

Now the formulas for the variance of the fiimre flood damage in the cost-benefit models by Van Dantzig and Eijgenraam mm out to be very valuable, since we can use them to calculate the optimal strategy for different values of the risk inversion index k. Of course, Equation 24 contains the variance of the total costs, but one should notice that this equals the variance of the future flood damage, since (within these models) the investment costs are not imcertain. 

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