Achieving renewable energy transition through financial stability of renewable energy companies and banking facility.

Investing heavily in the transition to renewable energy is essential for global sustainability. Companies in the renewable energy sector often use bank financing for day-to-day operations and capital expenditures. This research looks at the effect of financial ties between renewable energy companies and banks on both industries' viability as they make the switch to renewable power sources. We analyze a large worldwide sample of renewable energy firms and banks to see how these interdependencies affect the long-term viability of both industries. According to our findings, the effectiveness of the shift is heavily impacted by the degree of interconnection between renewable energy businesses and banks. Financing costs are reduced and investments in renewable energy projects are encouraged when banks have a higher exposure to renewable energy enterprises. In addition to highlighting the importance of these linkages, our research also emphasizes the possible hazards associated with them, such as financial contagion and systemic risk, and underscores the necessity for effective risk management methods. In conclusion, this study highlights the need for a coordinated strategy to the renewable energy transition that weighs the advantages and disadvantages of interconnection. We show that there are both positive and negative outcomes that can result from the relationship between financial institutions and renewable energy enterprises, and we highlight the duty of policymakers and regulators to ensure that banks have adequate exposure to the industry while closely monitoring associated risks.

Does green finance restrain corporate financialization?

Green financial policy is one of the important policy tools for China to implement the national carbon peak goal and carbon neutral vision through financial means. This policy has an important impact on the business strategy of corporates. Based on the data of listed corporates from 2013 to 2020, this study examines the impact mechanism of China's green financial reform and innovation pilot zones (GFRIPZ) on corporate financialization (CF) using the difference-in-difference method. The results show the following: (1) The implementation of GFRIPZ significantly restrains the CF. (2) GFRIPZ reversed the short-sighted behavior of firms and guided them to accelerate the green transformation and upgrading for long-term development. Firms' environmental capital expenditure and research and development expenditure increased significantly. (3) The restraining effect of GFRIPZ on CF is stronger in state-owned firms, firms with low-degree managerial myopia, and high-polluting firms. The research clearly identifies the causal relationship and mechanism between GFRIPZ and CF and reveals the formation mechanism and solution path of CF from the green finance perspective. In addition, this study has implications for guiding the green transformation of entity firms and stopping firms from deviating from their intended purpose.

Impact of source-separation of urine on treatment capacity, process design, and capital expenditure of a decentralised wastewater treatment plant.

In this study, the impact of urine diversion on the treatment capacity, treatment process, and capital costs of a decentralised wastewater treatment plant (WWTP) was simulated using BioWin. The data for simulation including for economic analysis were obtained from a real decentralised WWTP at Sydney. Simulation was conducted for two alternative process design scenarios of a WWTP: membrane bioreactor (MBR) without denitrification and anaerobic MBR in place of aerobic MBR and compared to existing process design. The simulation shows that with about 75% urine diversion (through source separation), the treatment capacity of the existing WWTP can be doubled although above 40% urine diversion, the impact appears less rapid. When the urine diversion exceeds 75%, it was found that the anoxic tank for biological denitrification becomes redundant and the current wastewater treatment process could be replaced with a simpler and much less aeration intensive membrane bioreactor (MBR) producing similar effluent quality with a 24% reduction in capital expenditure (footprint) cost. Anaerobic MBR can be a potential alternative to aerobic MBR although pre-treatment becomes essential before reverse osmosis treatment for water reuse applications. Sensitivity analysis has revealed that by operating the bioreactor at higher mixed liquor suspended solids concentrations (9 g/L instead of 5 g/L) could help increase the WWTP treatment capacity by about 3.5 times at 75% urine diversion. Hence, urine diversion (until nitrogen-limiting conditions occur above 75% urine diversion) can increase the treatment capacity of an existing WWTP and reduce the capital expenses due to reduced plant footprint.

Do hostile takeover threats matter? Evidence from credit ratings.

Exploiting a novel measure of takeover vulnerability mainly based on state legislations, we explore the effect of hostile takeover threats on credit ratings. Our results reveal that companies with more takeover exposure are assigned significantly better credit ratings. In particular, a rise in takeover vulnerability by one standard deviation results in an improvement in credit ratings by 7.89%. Our findings are consistent with the view that the disciplinary mechanism associated with the takeover market mitigates agency problems and ultimately raises firm value. Further analysis corroborates our conclusion, including propensity score matching, entropy balancing, and an instrumental-variable analysis. As our proxy for takeover susceptibility is plausibly exogenous, our results are more likely to show a causal effect.

Hospitalization costs for COVID-19 in Ethiopia: Empirical data and analysis from Addis Ababa's largest dedicated treatment center.

BACKGROUND: The COVID-19 pandemic has caused profound health, economic, and social disruptions globally. We assessed the full costs of hospitalization for COVID-19 disease at Ekka Kotebe COVID-19 treatment center in Addis Ababa, the largest hospital dedicated to COVID-19 patient care in Ethiopia. METHODS AND FINDINGS: We retrospectively collected and analysed clinical and cost data on patients admitted to Ekka Kotebe with laboratory-confirmed COVID-19 infections. Cost data included personnel time and salaries, drugs, medical supplies and equipment, facility utilities, and capital costs. Facility medical records were reviewed to assess the average duration of stay by disease severity (either moderate, severe, or critical). The data collected covered the time-period March-November 2020. We then estimated the cost per treated COVID-19 episode, stratified by disease severity, from the perspective of the provider. Over the study period there were 2,543 COVID-19 cases treated at Ekka Kotebe, of which, 235 were critical, 515 were severe, and 1,841 were moderate. The mean patient duration of stay varied from 9.2 days (95% CI: 7.6-10.9; for moderate cases) to 19.2 days (17.9-20.6; for critical cases). The mean cost per treated episode was USD 1,473 (95% CI: 1,197-1,750), but cost varied by disease severity: the mean cost for moderate, severe, and critical cases were USD 1,266 (998-1,534), USD 1,545 (1,413-1,677), and USD 2,637 (1,788-3,486), respectively. CONCLUSIONS: Clinical management and treatment of COVID-19 patients poses an enormous economic burden to the Ethiopian health system. Such estimates of COVID-19 treatment costs inform financial implications for resource-constrained health systems and reinforce the urgency of implementing effective infection prevention and control policies, including the rapid rollout of COVID-19 vaccines, in low-income countries like Ethiopia.

A novel measure of corporate carbon emission disclosure, the effect of capital expenditures and corporate governance.

The UK's 2050 net-zero emission target is one of the most ambitious goals in the world. Organisations should play a vital role by communicating a sufficient level of carbon emission information with the stakeholders. Motivated by the necessity of measuring the level of carbon disclosure, this paper provides a unique carbon emission disclosure measurement based on a sample of UK firms from 2013 to 2019. We apply different methods to assess the validity and reliability of our developed measurement. The results suggest that our measurement captures the actual CO2 emission, including scope 1, scope 2, and also captures the environmental, social and governance (ESG) score. Additionally, we explore the association between capital expenditure, corporate governance and the level of carbon emission disclosure. Further, the results show a positive relationship between capital expenditure and carbon emission disclosure. Also, there is a significant positive relationship between internal governance and carbon emission disclosure. Moreover, the analysis suggests that internal governance strengthen the relationship between capital expenditure and carbon emission disclosure. We also use quantile regression, and the findings show that capital expenditure and internal governance have a positive impact on carbon emission disclosure under all quantiles. Our data suggest that capital expenditure declines within the UK by around 53% over the last six years. Following the reduction in capital expenditure, the results demonstrate 39% decline in the CO2 emission level. The results also indicate that for every $1 million capital expenditure, approximately 2.75 Metric tons of carbon dioxide (MtCO2) emissions increase. Business investment is around 70% of the UK's total investment. Therefore, the reduction in capital expenditure is one of the primary reasons that might explain the decrease in the UK's overall CO2 emission level. The unique findings of this paper are relevant to the government, management and standard-setters.

Capital Expenditures Increased at Rural Hospitals That Merged Between 2012 and 2015.

EXECUTIVE SUMMARY: The number of rural hospital mergers has increased substantially in recent years. A commonly reported reason for merging is to increase access to capital. However, no empirical evidence exists to show whether capital expenditures increased at rural hospitals after a merger. We used a difference-in-differences approach to determine whether total capital expenditures changed at rural hospitals after a merger. The comparison group (rural hospitals that did not merge during the 2012 through 2015 study period) was weighted using inverse probability of treatment weights. The key outcome measure was logged total capital expenditures.Merging resulted in a 26% increase in capital expenditures and also was associated with a significant improvement in plant age. The postmerger improvement in plant age may have been partially attributable to merger-related accounting changes and partially attributable to increased capital expenses, possibly on long-term asset renovations and replacement.These findings suggest that through mergers, rural hospital board members and executives who have accepted or are considering a merger may improve a hospital's ability to increase capital expenditures. Further, increased capital investments in rural hospitals may be an important signal to the community that the acquirer intends to keep the rural hospital open and continue providing some volume and level of services within the community. Future research should determine how capital is spent after a merger.

Spatial production or sustainable development? An empirical research on the urbanization of less-developed regions based on the case of Hexi Corridor in China.

The relationships between spatial production, urbanization and sustainable development are becoming a focus of the international academic cycle. Urbanization dominated by spatial production driven by capital and power often produces and enlarges uneven development, which leads to multiple eco-environmental problems. Thus, the key to development lies in whether the pattern of urbanization is in harmony with the ecological environment. However, previous researches mainly concentrate on spatial production in developed countries or regions. The urbanization and sustainable development of less-developed regions, with complex and fragile ecological environments, are often overlooked. It is a new idea to explain the relationships and interactions between spatial production, urbanization and sustainable development based on less-developed regions by the theory of spatial production. The paper chooses the Hexi Corridor as a typical case, puts forward a conceptual framework and explores the process of spatial production from 2000 to 2017. The results reveal that urbanization in the Hexi Corridor is a multidimensional socio-spatial process: power and capital gave birth to a higher urbanization and accelerated the process of urbanization, however, the urban-rural gap between regions has not narrowed accordingly. Driven by comprehensive interests, local governments often take some extreme measures to forcefully promote the urbanization process, thereby violating the goals and requirements of sustainable development. At present, there is an urgent need to coordinate the relationship between urban and rural regions on different scales and transform the urbanization model from traditional spatial production to a new-type of urbanization with people-oriented and sustainable development.

The cost of a school based mass treatment of schistosomiasis in Ugu District, KwaZulu Natal, South Africa in 2012.

INTRODUCTION: The Neglected Tropical Diseases Roadmap of the WHO set targets for potential elimination as a "public health problem" for the period 2012-2020 in multiple countries in Africa, with the aim of global elimination of schistosomiasis as a "public health problem" by 2025. AIM: The purpose of the study was to estimate the cost from a provider's perspective of the Department of Health's Schistosomiasis Mass Drug Administration (MDA) in Ugu District, KwaZulu-Natal in 2012, with a view to project the costs for the entire KwaZulu Natal Province. METHODS: A total of 491 public schools and 16 independent schools in Ugu District, a predominantly rural district in KwaZulu-Natal with a total of 218 242 learners, were included in the schistosomiasis control programme. They were randomly selected from schools situated below an altitude of 300 meters, where schistosomiasis is endemic. A retrospective costing study was conducted using the provider's perspective to cost. Cost data were collected by reviewing existing records including financial statements, invoices, receipts, transport log books, equipment inventories, and information from personnel payroll, existing budget, and the staff diaries. RESULTS: A total of 15571 children were treated in 2012, resulting in a total cost of the MDA programme of ZAR 2 137 143 and a unit cost of ZAR 137. The three main cost components were Medication Costs (37%), Human Resources Cost (36%) and Capital items (16%). The total cost for treating all eligible pupils in KwaZulu-Natal will be ZAR 149 031 888. However, should the capital cost be excluded, then the unit cost will be ZAR 112 per patient and this will translate to a total cost of ZAR 121 836 288. CONCLUSIONS: Low coverage exacerbates the cost of the programme and makes a decision to support such a programme difficult. However, a normative costing study based on the integration of the programme within the Department of Health should be conducted.

The role of governments in mitigating SO2 pollution in China: a perspective of fiscal expenditure.

China has suffered from extensive and serious SO2 pollution. The central and provincial governments have reinforced environmental awareness by increasing fiscal expenditure for environmental protection for years. This paper extended an environmental Kuznets curve (EKC) framework to evaluate the direct and indirect spillover effects of environmental awareness of provincial governments on SO2 emissions, applying spatial econometric models. The empirical findings are as follows. (1) There exists an inverted U-shaped curve. Of 30 Chinese provinces, only 9 provinces, namely, 8 eastern provinces and Inner Mongolia, have passed the turning point at about 53,000 Yuan while the rest 21 provinces have not yet. (2) Expenditure for environmental protection is negatively correlated with SO2 pollution. In other words, environmental awareness of governments contributes to substantially reducing SO2 emissions. Besides, significant and negative spillover effects of environmental awareness are found, implying that provinces follow suit if neighboring provinces enhance environmental awareness by increasing spending on environmental protection, thereby reducing SO2 emissions. (3) The SO2 reduction policy implemented by the central government is found to have a negative impact on SO2 emissions, implying that the policy effectively works. To conclude, the central and provincial governments play pivotal roles in addressing the problem of SO2 pollution in China. Hence, more expenditure for environmental protection cannot be overstated for China's environmental quality improvements and sustainable development.

Profitability of Large Pharmaceutical Companies Compared With Other Large Public Companies.

Importance: Understanding the profitability of pharmaceutical companies is essential to formulating evidence-based policies to reduce drug costs while maintaining the industry's ability to innovate and provide essential medicines. Objective: To compare the profitability of large pharmaceutical companies with other large companies. Design, Setting, and Participants: This cross-sectional study compared the annual profits of 35 large pharmaceutical companies with 357 companies in the S&P 500 Index from 2000 to 2018 using information from annual financial reports. A statistically significant differential profit margin favoring pharmaceutical companies was evidence of greater profitability. Exposures: Large pharmaceutical vs nonpharmaceutical companies. Main Outcomes and Measures: The main outcomes were revenue and 3 measures of annual profit: gross profit (revenue minus the cost of goods sold); earnings before interest, taxes, depreciation, and amortization (EBITDA; pretax profit from core business activities); and net income, also referred to as earnings (difference between all revenues and expenses). Profit measures are described as cumulative for all companies from 2000 to 2018 or annual profit as a fraction of revenue (margin). Results: From 2000 to 2018, 35 large pharmaceutical companies reported cumulative revenue of $11.5 trillion, gross profit of $8.6 trillion, EBITDA of $3.7 trillion, and net income of $1.9 trillion, while 357 S&P 500 companies reported cumulative revenue of $130.5 trillion, gross profit of $42.1 trillion, EBITDA of $22.8 trillion, and net income of $9.4 trillion. In bivariable regression models, the median annual profit margins of pharmaceutical companies were significantly greater than those of S&P 500 companies (gross profit margin: 76.5% vs 37.4%; difference, 39.1% [95% CI, 32.5%-45.7%]; P < .001; EBITDA margin: 29.4% vs 19%; difference, 10.4% [95% CI, 7.1%-13.7%]; P < .001; net income margin: 13.8% vs 7.7%; difference, 6.1% [95% CI, 2.5%-9.7%]; P < .001). The differences were smaller in regression models controlling for company size and year and when considering only companies reporting research and development expense (gross profit margin: difference, 30.5% [95% CI, 20.9%-40.1%]; P < .001; EBITDA margin: difference, 9.2% [95% CI, 5.2%-13.2%]; P < .001; net income margin: difference, 3.6% [95% CI, 0.011%-7.2%]; P = .05). Conclusions and Relevance: From 2000 to 2018, the profitability of large pharmaceutical companies was significantly greater than other large, public companies, but the difference was less pronounced when considering company size, year, or research and development expense. Data on the profitability of large pharmaceutical companies may be relevant to formulating evidence-based policies to make medicines more affordable.

Importance of operating room case scheduling on analyses of observed reductions in surgical site infections from the purchase and installation of capital equipment in operating rooms.

BACKGROUND: We review the impact of the consequences of operating room (OR) management decision making on power analyses for observational studies of surgical site infections (SSIs) among patients receiving care in ORs with interventions versus without interventions involving physical changes to ORs. Examples include ventilation systems, bactericidal lighting, and physical alterations to ORs. METHODS: We performed a narrative review of operating room management and surgical site infection articles. We used 10-years of operating room data to estimate parameters for use in statistical power analyses. RESULTS: Creating pivot tables or monthly control charts of SSI per case by OR and comparing among ORs with or without intervention is not recommended. This approach has low power to detect a difference in SSI rates among the ORs with or without the intervention. The reason is that appropriate OR case scheduling decision making causes risk factors for SSI to differ among ORs, even when stratifying by surgical specialty. Such risk factors include case duration, urgency, and American Society of Anesthesiologists' Physical Status. Instead, analyze SSI controlling for the OR, where the patient had surgery, and matching patients using these variables is preferable. With α = 0.05, 600 cases per OR, 5 intervention ORs, and 5 or 1 control patients for each intervention patient, reasonable power (≅94% or 78%, respectively) can be achieved to detect reductions (3.6% to 2.4%) in the incidence of SSI between ORs with or without the intervention. CONCLUSIONS: By using this matched cohort design, the effect of the purchase and installation of capital equipment in ORs on SSI can be evaluated meaningfully.

The Unit and Scale-Up Cost of Postabortion Care in Tanzania.

INTRODUCTION: Based on research conducted in 2017, we estimated the cost to the Tanzanian health care system of providing postabortion care (PAC). PAC is an integrated service package that addresses the curative and preventive needs of women experiencing complications from abortion. PAC services include treating complications of miscarriage and incomplete abortion, providing voluntary family planning counseling and services, and engaging the community to reduce future unintended pregnancies and repeat abortions. METHODS: Thirty-one public and private health facilities, representing 3 levels of health care, were selected for data collection from key care providers and administrators in 3 regions. We gathered data on the direct costs of PAC startup (i.e., training and capital costs), as well as the recurrent costs of medicines, supplies, hospitalization, and personnel, and the indirect costs of PAC provision. We also gathered data to estimate PAC clients' out-of-pocket expenses. Estimates of the average cost per client (i.e., unit cost) were calculated for treatment of routine and severe abortion complications, treatment at different levels of health care, postabortion contraception, and various available treatment methods. RESULTS: We found that the unit cost of PAC training per provider was US$163.43. The total unit cost was $72.91. The unit recurrent cost of treating routine complications, which included 81% of the cases in our sample, was $36.23. The cost of treating incomplete abortion through manual vacuum aspiration was $22.63, while the cost of treatment with misoprostol was $18.74. The average cost of providing voluntary postabortion family planning was $11.56. We estimated an average client out-of-pocket expenditure on PAC of $22.96. CONCLUSION: We applied our unit cost estimates to those on PAC utilization and provision and unmet need for PAC that were derived from research conducted in Tanzania in 2013-2016, and we estimated an annual national cost of PAC of $4,170,476. We estimated the cost of providing PAC for all women who have abortion complications, including those who do not access PAC, at $10,426,299. Investing more resources in voluntary family planning and PAC treatment of routine complications at the primary level would likely reduce health system costs.

State tobacco control expenditures and tax paid cigarette sales.

This research is the first nationally representative study to examine the relationship between actual state-level tobacco control spending in each of the 5 CDC's Best Practices for Comprehensive Tobacco Control Program categories and cigarette sales. We employed several alternative two-way fixed-effects regression techniques to estimate the determinants of cigarette sales in the United States for the years 2008-2012. State spending on tobacco control was found to have a negative and significant impact on cigarette sales in all models that were estimated. Spending in the areas of cessation interventions, health communication interventions, and state and community interventions were found to have a negative impact on cigarette sales in all models that were estimated, whereas spending in the areas of surveillance and evaluation, and administration and management were found to have negative effects on cigarette sales in only some models. Our models predict that states that spend up to seven times their current levels could still see significant reductions in cigarette sales. The findings from this research could help inform further investments in state tobacco control programs.

Taxes, bankruptcy costs, and capital structure in for-profit and not-for-profit hospitals.

About 60% of the US hospitals are not-for-profit and it is not clear how traditional theories of capital structure should be adapted to understand the borrowing behavior of not-for-profit hospitals. This paper identifies important determinants of capital structure taken from theories describing for-profit firms as well as prior literature on not-for-profit hospitals. We examine the differential effects these factors have on the capital structure of for-profit and not-for-profit hospitals. Specifically, we use a difference-in-differences regression framework to study how differences in leverage between for-profit and not-for-profit hospitals change in response to key explanatory variables (i.e. tax rates and bankruptcy costs). The sample in this study includes most US short-term general acute hospitals from 2000 to 2012. We find that personal and corporate income taxes and bankruptcy costs have significant and distinct effects on the capital structure of for-profit and not-for-profit hospitals. Specifically, relative to not-for-profit hospitals: (1) higher corporate income tax encourages for-profit hospitals to increase their debt usage; (2) higher personal income tax discourages for-profit hospitals to use debt; and (3) higher expected bankruptcy costs lead for-profit hospitals to use less debt. Over the past decade, the capital structure of for-profit hospitals has been more flexible as compared to that of not-for-profit hospitals. This may suggest that not-for-profit hospitals are more constrained by external financing resources. Particularly, our analysis suggests that not-for-profit hospitals operating in states with high corporate taxes but low personal income taxes may face particular challenges of borrowing funds relative to their for-profit competitors.

Merger & Acquisition and Capital Expenditure in Health Care.

Investment, especially through merger and acquisition (M&A), is a leading topic of concern among health care managers. In addition, the implications of this activity for organization and market concentration are of great interest to policy makers. Using a sample of 2256 firm-year observations in the health care industry during the period from 1985 to 2011, this article provides novel evidence that managers learn from financial markets in making capital expenditure (CAPEX) and M&A investment decisions. Within the industry, managers in the Drugs subsector are most likely to do so, whereas managers in the Medical Equipment and Supplies are least likely to do so. We find informative stock prices improve firm financial performance. This article highlights the importance of financial markets for real economic activity in the health care industry.