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Charlie Nicholas Column: Why Scots cannot fear Costa Rica plus Killie and Partick latest



COSTA RICA is a name to send a chill down any Scotsman’s spine. For me it’s up there with Peru when I think of football nightmares on a world stage.




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EE customers warned about dangerous new scam that could cost you



A WORRYINGLY convincing new scam tries to scam EE monthly and SIM-only customers into handing over their login and payment details. Here is everything you need to know.




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FAIR FOR YOU calls for fees amnesty as Covid-19 opens up HIGH COST CREDIT traps



PEOPLE locked into high cost loans and rent-to-own schemes should be spared the extra fees charged if they fall behind with payments, says affordable provider Fair for You .




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Clarification – Labour tax bombshell UBI would cost taxpayers £520 billion – 27/01/20



On 23 September 2019, we published an article headlined 'Labour's tax bombshell: Corbyn's benefits splurge plot would cost taxpayers £520 billion' the article focused on Labour's potential objective of introducing a universal basic income and its associated costs.




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PDC Home Tour free live stream: How to watch PDC Home Tour online at no cost



The PDC Home Tour is a new darts tournament which sees top players compete from their homes. Express Sport is on hand with all the live stream information, including how to watch the action for free.




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M 3.6 COSTA RICA

Magnitude   M 3.6
Region  COSTA RICA
Date time  2020-05-09 15:29:30.0 UTC
Location  8.19 N ; 83.05 W
Depth  15 km




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Aircraft carrier costs to rise by at least a billion (again)

The cost of Britain's controversial new aircraft carriers is set to rise by at least £1bn, and perhaps almost £2bn, as a result of the government's decision taken last October to make them compatible with different aircraft than those originally envisaged.

I have learned that the working assumption of the contractors on the project, which are BAE Systems, Thales UK and Babcock, is that the carriers will now cost taxpayers some £7bn in total, compared with the £5.2bn cost disclosed by the Ministry of Defence last autumn - and up from the £3.9bn budget announced when the contract was originally signed in July 2008.

One defence industry veteran said the final bill was bound to be nearer £10bn, though a government official insisted that was way over the top.

The Ministry of Defence and the Treasury believe that total final costs could be nearer £6bn, if only one of the carriers is reconfigured to take the preferred version of America's Joint Strike Fighter aircraft.

An MoD official said no final decision had been taken on whether the first carrier to be built, the Queen Elizabeth, or the second carrier, the Prince of Wales, or both would be reconfigured.

He said it would probably be the case that changing the design specification for the Prince of Wales would be the cheapest option. But if that happened, it is not clear when - if ever - the Queen Elizabeth, due to enter service in 2019, would actually be able to accommodate jets (as opposed to helicopters).

Whatever happens, the increase in the bill will be substantial - and is only regarded by the Treasury as affordable because the increment is likely to be incurred later than 2014/15, when the expenditure constraints put in place by the Chancellor's spending review come to an end.

The Treasury is adamant that the MoD will receive no leeway to increase spending before then.

An MoD spokesman sent me the following statement late last night:

"The conversion of the Queen Elizabeth Class...will allow us to operate the carrier variant of the Joint Strike Fighter that carries a greater payload, has a longer range and is cheaper to purchase. This will give our new carriers, which will be in service for 50 years, greater capability and interoperability with our allies. Final costs are yet to be agreed and detailed work is ongoing. We expect to take firm decisions in late 2012."

The disclosure of the rise in costs is bound to reopen the debate about whether the UK really needs new carriers, especially since the UK will be without any aircraft carrier till 2019, following the decision to decommission Ark Royal.

British Tornado jets are currently active in Libya, flying from a base in Italy, without the use of a British aircraft carrier.

The latest increase in likely expenditure on the enormous carriers - which are almost the size of three football pitches - stems from the decision of the Ministry of Defence in October to change the design one or both of them so that they can be used by the carrier version of America's Joint Strike Fighter.

This would mean they have to be fitted with catapults and traps - or "cats and traps" - rather than ramps.

The likely final cost will depend on whether the cats and traps are cheaper traditional steam devices, or newer-technology electromagnetic ones - and also whether the cats and traps are fitted to both carriers or just one.

Industry and government sources tell me that even if the MoD goes for the cheaper option, and even if the cats and traps are fitted to only one carrier, the additional bill will still be of the order of £1bn.

The hope however would be that in the longer term savings could be achieved because the maintenance costs of the more conventional Joint Strike Fighter should be lower.

One of the reasons the refit could be relatively more expensive is that for one of the carriers, HMS Queen Elizabeth, there would have to be a retrofit - because so much work has already been done on it.

"Retrofitting is always very pricey" said a senior defence executive.

The carrier project has been beset by controversy and cost increases.

In June 2009, I disclosed that the carrier costs had soared by more than £1bn as a result of a decision taken by the previous government to delay their entry into service.

Then last October the government, in its Strategic Defence and Security Review, came close to cancelling one or both carriers.

In the end, it committed to build both, but with the strange caveat that it might end up using only one of them. This was the reason given by the Prime Minister David Cameron in the Commons for building both:

"They [the previous government] signed contracts so we were left in a situation where even cancelling the second carrier would actually cost more than to build it; I have this in written confirmation from BAE Systems".

However in a memo to the House of Commons Public Accounts Committee (PAC), the Ministry of Defence estimated that cancelling both contracts would have saved £2bn and cancelling just one would have saved £1bn.

The MoD told MPs that "as the cancellation costs would have had immediate effect, the costs in the short term would have been significantly higher than proceeding with both carriers as planned; nearly £1bn more in financial year 2011/12 if both carriers had been cancelled".

The MoD was also concerned that cancelling the carriers would have undermined British capability and know-how in the manufacture of complex warships.

The carriers, called Queen Elizabeth Class Aircraft Carriers, are being built by the Aircraft Carrier Alliance, whose members are the UK defence giant BAE systems, the British engineering group Babcock, and Thales of France. The Ministry of Defence is also described as both a member of the Alliance and a customer.

Update 15:06:It has been pointed out to me, by what you might term a grizzled sea dog, that the UK does still possess two ships that can take aircraft. They are HMS Illustrious and HMS Ocean (which is a commando carrier with a flat top).

However they can't accommodate jet airplanes, only helicopters - so for veteran sailor it was a terrible error for the government to scrap the illustrious Harrier jumpjet.

He also takes the view, which I've heard from many other military personnel, that it would be bonkers to convert only one of the new carriers to take the carrier version of the Joint Strike Fighter - because if that were to happen, one of the carriers would be an enormous white elephant, and the other would not be able to provide a service for 100% of the time (it would need periodic servicing).

That said, the cost of retro-fitting the first carrier being built now and also redesigning the other one would certainly be nudging £2bn, maybe more.

He believes there is powerful strategic logic to building two new huge ships able to handle jets.

The problem for David Cameron is that he may find it hard to make the strategic case, since last autumn he justified building the two on the basis that it would not save any money to cancel one - which is not the most positive case for what turns out to be a very substantial public investment that anyone has ever advanced.




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The cost of compromise

Washington teeters on the brink. If there is no agreement on a budget by midnight on Friday, the federal government will shut down. While cops and soldiers, air traffic controllers and others deemed essential won't down tools this is serious, at least according to the Obama administration. A senior administration official has told us loans to small businesses and home buyers will stop, which will have an impact on an already fragile housing market. Military and civilian workers won't be paid. The lions at the zoo will be fed (and unlike last time their waste should be collected) but the gates won't open to visitors. National parks will close. This is, of course, the most serious, as I am planning a vacation to one of them next week.

I am just back from the Capitol, and talking to people at a Tea Party rally. Their view might be summed up as "bring it on!" They were chanting "Shut it down!" Several made the point that if non-essential parts of the government shut down, they'd be quite happy. If it's not essential, the view is, then the government shouldn't be doing it anyway.

I suspect there will be a deal. There is too much for both sides to lose in the blame game that would follow. But the strength of the Tea Party has already made it hard for their leadership to compromise, and will make selling any deal tough. President Barack Obama and the Democrats don't have quite the same problem but the cuts he has accepted have already upset supporters.

Compromise is a peculiar business, I reflected as I started reading a book called At the Edge of the Precipice, by Robert Remini, the former historian of the US House of Representatives. It is about the 1850 compromise over slavery. He writes that the man at the centre of this, Henry Clay, "understood the importance of compromise... each side must feel that it has gained something that is essential to its interest as the result of the compromise. To achieve that goal each side must surrender something important to the opposing side. Both sides can then claim victory."

His contention is that compromise prevented an early civil war that the North would have lost, having neither leadership nor material to win at that stage. The argument is that it prevented the splitting of the US into two nations and thus was a good move. All history is hindsight, but I am uncertain about praising an agreement on the grounds that it turned out that it came unstuck later with better results. It was hardly the argument at the time. And compromises depend who is at the table. The compromise was between white gentlemen, while the slaves themselves had no say. Perhaps they might have had some thoughts about the value of compromise.

What's this got to do with today's politics? Simply that like Mr Remini, most Americans admire politicians who can behave with dignity and find a way through a difficult problem, by giving and taking. Bipartisanship is one of the highest ideals of US politics. But many of the politicians might question the morality of this. Enough of them might see the matters of practicality and principle at stake as too important to allow the other side to claim any sort of victory.




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New cost details emerge in California's secretive coronavirus masks deal with Chinese company

Documents obtained from state Treasurer Fiona Ma's office through a records request include an invoice from a BYD subsidiary for 'N95 face masks.'




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Costa Rica timeline

A chronology of key events




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Costa Rica profile

Key facts, figures and dates




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The Polaris Slingshot is a car-motorcycle mashup that costs $33,000 and can do 0-60 mph in 5 seconds — on 3 wheels.

  • I tested a roughly $33,000 Polaris Slingshot R, a three-wheeled "autocycle."
  • The three-wheeler category includes vehicles from Can-Am and Harley-Davidson, offering a motorcycle experience in a less demanding package.
  • My Slingshot R had a new, Polaris-developed, 203-horsepower engine and an automatic transmission.
  • In all but three US states, no motorcycle license is required to operate the Slingshot (New York, Massachusetts, and Alaska continue to require the motorcycle certification).
  • The Slingshot is insanely fun, with a modest learning curve — it's a great alternative to a two-wheeler, although the price is definitely steep for the Slingshot R.
  • Visit Business Insider's homepage for more stories.

Motorcycles are cool, but they aren't for everybody. Fortunately, there are some alternatives out there that offer an equally compelling, open-air experience.

One of the most popular is the the Polaris Slingshot, manufactured by the Minnesota-based powersports company. Until recently, Slingshots were available only with manual transmissions and GM-sourced engines, but for 2020, Polaris has updated the autocycle with an in-house motor and an automatic.

The automatic transmission in particular really broadens the Slingshot's potential. So I was excited to sample the machine, which I first saw about five years ago.

Polaris was kind enough to loan me a tester for a few weeks. Here's how it went:

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The Polaris Slingshot is a three-wheeled autocycle/motorcycle that Polaris industries has produced since 2014. My 2020 Slingshot R tester cost about $33,000 and was outfitted in a menacing red-and-black paint job.

The cheapest Slingshot is about $20,000.



This wasn't my first crack at a Slingshot. Polaris brought the vehicle to Insider's New York offices when the vehicle first launched.



And I generally have a gander at the Slingshot when I visit the annual New York motorcycle show.



The Slingshot is classified as either a motorcycle or an autocycle, depending on which state it's being operated in.



Yep, it looks like the Batmobile. Or Batcycle. Hard to avoid feeling like a superhero when you're behind the wheel. In all but three US states, no motorcycle license is required to drive the Slingshot. In New Jersey, you are required to wear a helmet.

Up front, you have 18-inch forged aluminum wheels, with an 20-incher at the back. The brakes have two-piece composite rotors.



Permanent open-air motoring isn't for everybody. Polaris does sell and older model, the Grand Touring, which has a cockpit canopy. The Polaris R has a waterproof interior and drain holes in the floorboards, should you get caught in bad weather.



My tester was the top-level "R" trim, complete with dual roll bars for drier and passenger.



Let's talk fender fairings! The Slingshot's are dramatic and large — I was reminded of Chevy Corvettes while driving this thing. Like a motorcycle, there's no rear-view mirror, so you have to adjust slightly to using the sideviews.



There's a new engine under the hood. Previously, Polaris used a 2.4-liter, four-cylinder GM-sourced Ecotech motor, making up to 175 horsepower. But my R had a ProStar four, also at 2.4-liters, cranking out 203 horsepower with a five-speed automatic transmission (a manual remains available). It's an in-house engine that was impressive in action.

The top speed is limited at 125 mph, and the 0-60mph run, according to Polaris and confirmed by yours truly, is about five seconds.

The four-banger redlines at 8,500 rpm and even with the automatic transmission does a pretty fair imitation of proper motorcycle acceleration. The auto is a tad crunchy, but in this context, that's a plus. It keeps you aware of what the engine is doing.



The rear wheel — fat and wide — is yoked to the motor and transmission with a belt drive. The suspension is surprisingly compliant, but you do have to be mindful of bumps, potholes, and manhole covers if you want to preserve you lower spine.



Polaris says the interior has been upgraded for 2020. No one would call it premium, but for a vehicle like this, it's rather comfortable.



The steering wheel is leather-wrapped, multifunctioned, and flat-bottomed to make getting into and out of the driver's seat easier.



The instrument cluster is a basic analog affair with a central digital display. The red button to on the right steering-wheel spoke allows you to switch between Comfort and Slingshot modes (the latter being the high-performance option).



The bucket seats are waterproof and extremely well-bolstered, with three-point seat belts.



The Slingshot's tubular frame is apparent in the doorless frame.



Not really much cargo capacity here, although I did use the Slingshot for a grocery-store run and quick jaunt to Target to buy a basketball.



There is a place to stow a smartphone, located just above the push-button gear selector.



The Slingshot also has push-button start-stop.



The glove compartment is the only other storage available ...



... And it's actually pretty roomy. One could stash a rain jacket in there, for example.



The RideCommand infotainment system is basic — but good! On a vehicle such as this, I wasn't expecting much, but the audio setup sounded decent, the screen was responsive, and Bluetooth and USB connectivity was on-par with what you'd find in any modern automobile.



There's even GPS navigation, which can display a map and provide turn-by-turn guidance.



The ride-mode selector is doubled in the infotainment system.



So what's the verdict?

I love three-wheelers. They aren't as cool as two-wheeled motorbikes, but they provide easy access to open-air motoring, and the driving/riding experience is much more engaging than what you find in convertible automobiles.

For anybody who dislikes the impracticality of motorcycles but wants to partake of the open-road lifestyle, machines like the Slingshot (the Can-Am Spyder and the Harley-Davidson Freewheeler, to name two) are ideal.

Not for nothing, they also offer aging riders a chance to yank their helmets and biker jackets out of storage to pursue moderately safer riding. With the Slingshot, gearing-up isn't necessary.

The trade-off, of course, is price. The Slingshot R that I tested costs more than an entry-level car or SUV. So, an expensive plaything. But there's nothing wrong with that. Everybody needs a hobby.

No doubt about it, the Slingshot captures attention. I lost count of how many little kids a stopped in their tracks as I tooled around the Jersey suburbs. The last vehicle that provoked such astonishment was the Lamborghini Huracán Performante. If you become a Slingshotter, prepare to be pointed at and asked for photo-ops.

Driving-wise, the Slingshot scratches an itch: on the road, the experience is unexpurgated — you don't have to be constantly vigilant, as you would on a bike, but you do need to remain aware. Highway trips are demanding. And noisy. And exhilarating. The Slingshot R is also fast and torque-y and the power goes to the single back wheel, so the while the two-wheeled front is stable, the back end can get pretty wiggly, especially in Slingshot mode, if you stomp the throttle.

I had iffy springtime Northeast weather to contend with, so I took the Slingshot out only on warm and sunny days; the rest of the time, I parked it in my garage. But the vehicle can handle being rained on, and one could also buy a cover to protect it from the elements. To be honest, however, I think it's a better choice in warm, dry climates. 

The performance is aggressively go-kart-y. This thing will make you a better drive, thanks to its point-and-shoot steering, crisp suspension, and easy access to power. It's insanely fun on curves and into corners. But it's also worthy of short road trips. In fact, the relative comfort was a shocker: I took the Slingshot out for a few hours one day and suffered no ill-effects to my lower back.

Drawback? The design is thoroughly sporty, so if you don't go in for that, the Slingshot might not be your bag. It isn't a throwback, nor is it at all steam-punky. 

It also isn't a motorcycle, in that there aren't any handlebars, you don't throw a leg, and the single wheel takes up the rear. 

But the Slingshot is a absolute blast, and if you're a weekend warrior who wants to carve up a canyon or a country road without having the grapple with a motorcycle's demands — and you don't mind dropping some dollars — the Slingshot is perfect.






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11 Costly Cruise Mistakes

Discover the 11 Costly Cruise Mistakes that cruise passengers make most often, And how you can avoid making them. Drawing on the 73 cruises I have done to date, and the mistakes that I either made or seen other cruisers make, this is the list of things you need to be aware of to make sure you do not waste money, spend too much or have to fork out a lot of extra money when cruising.

SUPPORT THE CHANNEL BY:
Buying my Cruise T-shirts: http://bit.ly/TFTStore
Booking your next cruise with CRUISEDIRECT.COM: http://bit.ly/TFTBookCruise


Gary Bembridge's Tips For Travellers aims to help you make more of your precious travel time and money on land and when cruising the oceans or rivers of the world. To help you, in every video I draw on my first-hand tips and advice from travelling every month for over 20 years and 60+ cruises.

Follow Tips For Travellers on:
- Instagram: http://www.instagram.com/garybembridge
- Facebook: http://www.facebook.com/tipsfortravellers
- Twitter: http://www.twitter.com/garybembridge




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Alex Acosta gave a pass to Epstein years ago. He’s still at it as labor secretary.

His department has ignored visas for trafficking victims.




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strataconf: Building Big Data applications now easier http://t.co/jaATalPL4P Hadoop analytic engines simplify creation of low-cost, scalable apps

strataconf: Building Big Data applications now easier http://t.co/jaATalPL4P Hadoop analytic engines simplify creation of low-cost, scalable apps




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Fin24.com | Icasa wants companies to lower data cost during coronavirus outbreak

The communications regulator is asking telecom companies to consider lowering the cost of data in a bid to ensure productivity during the period the coronavirus outbreak.




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7 Common Negotiation Mistakes to Avoid at all Costs

Many often consider negotiation an arduous task, as it involves having conversations with people, where both parties are doing their best to protect personal interests. Going over negotiations while maintaining relationships remains relevant to businesses and investments. It hardly comes easy to conclude a negotiation that keeps both parties happy, while overlooking small processes may […]

The post 7 Common Negotiation Mistakes to Avoid at all Costs appeared first on ReadWrite.




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AT#116 - Travel to Costa Rica

Costa Rica




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AT#328 - Adventure Travel in Costa Rica

The Amateur Traveler talks about adventure travel in Costa Rica. From rafting on the Pacuare river and ziplining through the Monteverde Cloud forest to snorkeling off the Nicoya Peninsula, Costa Rica can be a great destination for adventure travel.




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AT#339 - Travel to Costa Brava, Spain

The Amateur Traveler talks to Sherry Ott about Costa Brava Spain. Costa Brava is in Catalonia north of Barcelona on the rugged coastline of Spain. It also extends as far inland as the Pyrenees and includes farming country and medieval towns.




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AT#698 - Travel to Costa Rica

Hear about travel to Costa Rica as the Amateur Traveler talks to Costa Rica travel experts Sam and Yeison from mytanfeet.com about their beautiful country.




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6 of the best gaming laptops that cost less than $1,000

BEST DEALS ON GAMING LAPTOPS:


My first gaming laptop cost $1,500 more than 10 years ago, and that was considered affordable. It wasn't a top-of-the-line model, but it wasn't a slouch either, sporting one of the better mid-tier graphics cards and a reliable processor/RAM combination.  

But my, how things have changed.

Today, you can go on Amazon and find plenty of laptops for less than $1,000 that would have been at least $1,500 a few years ago, thus opening doors to people who want to try out PC gaming for themselves. (And if it's Prime Day or Black Friday or Cyber Monday, you can expect deal prices to dip even lower.) But sorting through all of the options and deciding which is best presents its own unique challenge. Read more...

More about Gaming, Laptop, Mashable Shopping, Tech, and Gaming
IMAGE: Amazon

OUR TOP PICK

Lenovo Legion Y520

Lenovo balances price and power to deliver a well-rounded gaming laptop that can handle most of what the average gamer can throw at it.

  • Processor: Intel Core i5-7300HQ
  • RAM: 8GB
  • Graphics card: NVIDIA GeForce GTX 1050 Ti 4GB
  • Storage: 256GB SSD
  • Screen: 15.6" Full HD (1920x1080) LED-lit
$999.99 from Amazon

IMAGE: Amazon

BEST FOR A BUDGET

Asus TUF Gaming FX504

The Asus TUF Gaming FX504 offers reliable performance without breaking the bank for gamers on a budget.

  • Processor: Intel Core i5-8300H
  • RAM: 8GB
  • Graphics card: NVIDIA GTX 1050 2GB
  • Storage: 1TB FireCuda SSHD
  • Screen: 15.6” Full HD
$999.99 from Amazon

IMAGE: Amazon

BEST POWER FOR THE PRICE

Dell G5 Gaming Laptop

With plenty of graphical power for an affordable price, the Dell G5 gaming laptop is proof that price doesn't have to lock out performance.

  • Processor: Intel Core i5-8300H
  • RAM: 8GB(up to 32GB)
  • Graphics card: NVIDIA GeForce GTX 1060
  • Storage: 128GB SSD and 1TB HDD
  • Screen: 15.6-inch FHD (1920 x 1080) IPS Anti-Glare LED-Backlit Display
$937 from Amazon

IMAGE: Amazon

BEST FOR NEW GAMERS

Dell Inspiron 15 5000 Gaming Edition 5577

If you're new to the gaming scene and looking for a good place to start, the Dell Inspiron 15 5000 is a great pick.

  • Processor: Intel Core i5-7300HQ
  • RAM: 8GB
  • Graphics card: NVIDIA GeForce GTX 1050 4GB GDDR5 VRAM
  • Storage: 128GB SSD and 1TB HDD
  • Screen: 15.6" Full HD (1920x1080) anti-glare LED-backlit
$749 from Amazon

IMAGE: Amazon

BEST MULTI-PURPOSE LAPTOP

Acer Aspire 7

With the Acer Aspire 7, you'll be ready for anything life or gaming has to throw at you.

  • Processor: Intel Core i7-8750H
  • RAM: 8GB
  • Graphics card: NVIDIA GeForce GTX 1050 Ti with 4 GB of dedicated GDDR5 VRAM
  • Storage: 128GB SSD and 1TB HDD
  • Screen: 15.6" Full HD (1920 x 1080) Widescreen LED-backlit IPS Display
$839.99 from Amazon

IMAGE: Amazon

BEST NAME BRAND LAPTOP

OMEN by HP 15.6" Gaming Laptop

HP integrates its trusted brand design with plenty of power in the Omen 15.6" gaming laptop.

  • Processor: Intel Core i5-8300H
  • RAM: 12GB
  • Graphics card: NVIDIA GeForce GTX 1050 Ti with dedicated 4 GB GDDR5
  • Storage: 128GB SSD and 1TB HDD
  • Screen: 15.6" diagonal FHD IPS BrightView micro-edge WLED-backlit
$929 from Amazon




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Lebanon Is Paying the Cost of Its Dysfunctional Politics

26 February 2020

Nadim Shehadi

Associate Fellow, Middle East and North Africa Programme
A series of fights to political stalemate have led its economy to the brink and cut it off from its natural economic partners in the Gulf.

2020-02-25-Leb1.jpg

Protests against economic conditions and government inaction turned violent in January. Photo: Getty Images.

To understand Lebanon’s financial collapse, look to its politics.

The country has been deeply damaged by an increasingly dysfunctional political system. A series of compromises have alienated it from its main markets in the Gulf and strangled its economy; anyone that has glanced at fluctuations in Lebanese bank deposits over the last 10 years can see the correlation.

Imagine if Boris Johnson or Donald Trump were obliged to form joint governments with Jeremy Corbyn or Bernie Sanders. The result would be paralysis and lack of accountability as each party pulls the country in opposite directions and blames the other for the state of limbo. This has been the state of affairs in Lebanon since the Doha agreement of 2008. 

That agreement followed an 18-month siege that paralyzed Beirut and an attack on the city by Hezbollah’s ‘black shirts’. The Doha formula imposed governments of national unity between Prime Minister Saad Hariri’s pro-Saudi camp and Hezbollah’s pro-Iran camp and their respective internal allies.

The pattern was set: each period of subsequent paralysis was followed by further compromise as the tug of war pulled the country away from its principal economic partners, the Arab Gulf states, with the regional balance of power tilting towards Hezbollah. 

It was not supposed to be like this. The Baabda Declaration in June 2012, reached after a process of national dialogue, was meant to secure Lebanon’s neutrality in regional conflicts, with both sides promising to hold back on external alliances and coexist despite difference over major regional issues like the war in Syria, the standoff between the US and Iran or relations with Israel or the Gulf states.

This has worn away. The Baabda declaration itself became a sham when Hezbollah inserted itself into the war in Syria in support of the Assad regime and overtly got involved in Iraq and Yemen as an Iranian proxy. This was followed by Saudi opposition to concessions by Hariri that led to the election of General Michel Aoun, an ally of Hezbollah, as president in October 2016; again, after a political paralysis that lasted 29 months with no active government and no head of state.  

The Saudis were also furious when President Aoun’s son-in-law, Foreign Minister Gebran Bassil, abstained from condemning the burning of the Saudi embassy in Tehran at an Arab League meeting in Cairo in January 2016, citing the need to preserve national unity.

Fearing that he was simply providing Hezbollah with protection in the guise of compromise, the Saudis pressured Hariri to resign in November 2017 during a trip to Riyadh, but he later challenged that by retracting on his resignation when back in Beirut. Lebanon was caught between two sides, and as the regional conflict intensified from tension to open confrontation, neutrality was no longer an option.

Gulf connections

An estimated 350,000 Lebanese expats live and work in Saudi Arabia, the UAE, Qatar and Kuwait. These countries are also the main clients for Lebanese contractors, consultants and advertising companies, some of which have offices there. The domestic tourism industry relies heavily on Arab Gulf visitors and they are a principal source of foreign investments especially in the real estate sector.

Lebanon also enjoyed a certain degree of political and economic protection from the US and the Gulf, and Hezbollah benefited indirectly from that protection, as it also shielded it to a certain degree from sanctions.

The deterioration of relations meant that the country was cut off by its Gulf partners. This was manifested in travel bans for Gulf Cooperation Council (GCC) nationals to Lebanon and a decrease in investments and bank deposits, as well as a decrease in remittances from Lebanese expats, partly because of economic crisis in the Gulf countries themselves.

Saudi Arabia withdrew $4 billion of aid to the Lebanese army and internal security forces, and no aid or deposits were forthcoming as the economic and financial situation deteriorated. 

The costs to the Lebanese economy include the opportunity cost created by the annual threat of war with Israel, after which trips are cancelled and projects postponed. Hezbollah also controls a section of Beirut port where it pays no duty or taxes. Add to that the economic fallout from the war in Syria, such as the impact on exports, the inflow of refugees and the cost of Hezbollah’s involvement.

The burden of these political factors is difficult to estimate but it constitutes the ransom that the Lebanese economy bears as a cost of the compromise. This is not to absolve Lebanese politicians from corruption or bankers of mismanagement but to add that political factors cannot be ignored.

The cumulative cost and economic impact of being cut off from its main economic partner eventually bankrupted the country. The fiscal and financial aspects, with Lebanon’s inability to service its debt, are but a reflection of these political factors. In the long run, the key to avoiding complete collapse is to restore relations with the GCC and free Lebanon from that very costly grip.




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First ever global analysis of refugees’ energy use: High costs and poor supply undermine humanitarian assistance

11 November 2015

20151119MovingEnergyInitiative.jpg

A migrant girl looks at a light illuminating a camp site of refugees and migrants on the Greek island of Lesbos, 4 October 2015. Photo: Getty Images.

About 90 per cent of refugees living in camps have no access to electricity and many lack any form of lighting at night, says a Chatham House report for the Moving Energy Initiative. Energy poverty in refugee settlements is not on the radar of international initiatives and humanitarian agencies are ill-equipped to deal with the scale of need. 

Heat Light and Power for Refugees: Saving Lives, Reducing Costs zooms in on the energy needs of refugees and displaced people worldwide, and presents the first ever estimates of the volume and costs of what they use.

'The problem goes beyond electricity. 80 per cent of those in camps rely on firewood for cooking and, as a result, we estimate that some 20,000 people die prematurely each year due to the pollution from indoor fires. Exposure to extremes of cold and heat are also killers for people living in flimsy, temporary shelter,' says Glada Lahn, senior research fellow at Chatham House. 'The current lack of provision for energy undermines the fundamental aims of humanitarian assistance,' she adds.

There are nearly 60 million forcibly displaced people in the world, and they pay staggering costs for energy. The 83,277 households living in Dadaab in Kenya, the world’s largest refugee settlement, spent an estimated $6.2 million on firewood last year, which accounts for approximately 24 per cent of their overall household income. (The average UK household spent 4 per cent of its income on energy in 2011.) In Uganda, almost half of refugee households surveyed by the UNHCR skip meals because they do not have enough fuel to cook with.

'The imperative is to find humane, creative and cost-effective ways to respond to the needs of so many individuals, most of whom are women and children.  Improving access to clean, safe and sustainable energy offers a promising way forward,' says Kofi Annan in the report’s foreword.

The report calls for an overhaul in the way that heat, light and power are delivered in humanitarian crises. It makes the case for new partnerships between humanitarian agencies and private providers to increase clean energy access in refugee settlements. Investment in energy infrastructure will also benefit host communities in some of the world’s poorest countries.

'As refugee households spend approximately $2.1 billion on energy each year, developing local markets for energy services could be part of a mix of solutions,' adds Lahn. 'Using green, culturally appropriate technologies could save lives, reduce CO2 emissions by 11 million tonnes per year and radically improve living standards. Introducing even the most basic solutions, such as improved cookstoves and basic solar lanterns, could save $323 million a year in fuel costs.' 

Other findings include:

  • Rape and violence against women is common in many unlit camps. Only 4 per cent of women and girls in households in the Goudoubo camp in Burkina Faso would go out after dark due to the lack of streetlights.
  • Wood equalling around 49,000 football pitches worth of forest (64,700 acres) is burned by displaced families living in camps each year, mainly in countries suffering severe deforestation, because they have no alternative sources of energy.
  • Firewood consumption emits nearly twice as much CO2 as liquid petroleum gas and produces little energy in comparison to its carbon intensity.

International Development Minister Grant Shapps said:

‘Across sub-Saharan Africa, hundreds of millions of people still do not have access to electricity. Women and girls are at risk of violence after dark, families are forced to inhale toxic kerosene fumes, and energy remains unaffordable for many.

‘With the technology in place and investors coming on board, the time to act is now. The UK's Energy Africa campaign is already kick-starting a solar revolution across the continent.

‘Supporting the Moving Energy Initiative is another way Britain can help boost access to clean, reliable and affordable energy. This will transform people’s lives and help achieve the UN’s goal of universal energy access by 2030.’

Editor's notes

  • Read Heat Light and Power for Refugees: Saving Lives, Reducing Costs by Glada Lahn and Owen Grafham.
  • To link back to the report in an article, please use this landing page for the final report.
  • The Moving Energy Initiative (MEI) is a collaboration between GVEP International, Chatham House, Practical Action Consulting, the Norwegian Refugee Council (NRC) and the United Nations High Commissioner for Refugees (UNHCR). The report is supported by the UK Department for International Development through the Humanitarian Innovation and Evidence Programme.
  • The number of refugee households in Dadaab, Kenya is as of May 2015.
  • Chatham House will host a press briefing with MEI programme board member Michael Keating and authors Glada Lahn and Owen Grafham on Thursday 12 November at 10:30-11:30 GMT. To register, or for interview requests, please contact the press office.
  • All figures are original and based on estimations and calculations prepared for the Moving Energy Initiative. Chatham House designed a model offering the first estimates of the scale and cost of energy use and CO2 emissions among forcibly displaced households worldwide, not including people affected by natural disasters. For more details on the populations considered in the report and used in the model, contact the authors.
  • The authors are available to answer questions from the media. Please contact the press office.

Contacts

Press Office

+44 (0)20 7957 5739




cost

'Sweet City': the Costa Rica suburb that gave citizenship to bees, plants and trees

"Pollinators were the key," says Edgar Mora, reflecting on the decision to recognise every bee, bat, hummingbird and butterfly as a citizen of Curridabat during his 12-year spell as mayor.




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CBD Press Release: Governments and Organizations involved in Biosafety Capacity-Building Projects convene in Costa Rica.




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CBD Communiqué: Costa Rica becomes the 38th Signatory of the Nagoya Protocol




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CBD News: Statement by Mr. Braulio Ferreira De Souza Dias, CBD Executive Secretary, on the occasion of the Inter-Regional Capacity-Building Workshop on REDD+ and Aichi Biodiversity Targets, San Jose, Costa Rica, 29 August 2014




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CBD News: Statement by Mr. Braulio Ferreira De Souza Dias, CBD Executive Secretary, on the occasion of the Inter-Regional Capacity-Building Workshop on REDD+ and Aichi Biodiversity Targets, San Jose, Costa Rica, 29 August 2014




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CBD News: Statement by Mr. David Cooper, CBD Deputy Executive Secretary/Officer-in-Charge, at the Opening of the Sustainable Ocean Initiative Capacity-Building Workshop for the Wider Caribbean and Central America, San José, Costa Rica, 20-24 Februar




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Benefits of higher doses of certain medicines fail to justify costs and risks, study shows

(Oregon State University) Clinical trial data behind drug dose recommendations for elevated cholesterol and chronic obstructive pulmonary disease illustrate how larger doses may not be worth the extra costs for many types of patients.




cost

Engage China to Uphold Multilateralism – But Not at Any Cost

12 June 2019

Harriet Moynihan

Senior Research Fellow, International Law Programme
Where China’s interests align with those of the international community, there are opportunities for the country’s influence and economic power to strengthen the rules-based international order. Where they do not, states that traditionally support that order should join together to push back.

2019-02-01-China.jpg

Students holding Chinese national flags watch the live broadcast of the 40th anniversary celebration of China's reform and opening-up at Huaibei Normal University on 18 December. Photo: Getty Images.

China’s adherence to the rules-based international system is selective, prioritizing certain rules in favour of others. States supportive of that ‘system’ – or, as some argue, systems[1] – should identify areas of mutual strategic interest so that they can draw China further into the global rules-based order and leverage China as a constructive player that potentially also contributes to improvements in such areas. This is particularly apposite at a time when the US is in retreat from multilateralism and Russia seems bent on disrupting the rules-based international order.

Supportive player

There are many reasons for actively engaging with China on mutual areas of interest. China is a committed multilateralist in many areas, recognizing that often international cooperation and frameworks hold the key to its domestic problems, for example in the fields of environmental sustainability and financial regulation.

China’s economic power is valuable in upholding international institutions: China is the UN’s third-largest donor (after the US and Japan) at a time when the UN is facing budgetary shortfalls. China is also the second-highest contributor to the UN peacekeeping budget, and the largest contributor of peacekeeping forces among the five permanent members of the UN Security Council.

China also has a valuable role to play in the settlement of international disputes over trade and investment. China is a big supporter of the World Trade Organization (WTO)’s dispute settlement mechanism, and one of its most active participants;[2] China is currently playing an active role in negotiations to save the WTO’s appellate mechanism from folding in the wake of the US’s refusal to nominate new judges.

The last 15 years have also seen a major shift in Chinese attitudes to investment arbitration, from a general suspicion and limitation of arbitration rights to broad acceptance and incorporation of such rights in China’s trade and investment treaties. China is actively engaged in multilateral negotiations through the UN Commission on International Trade Law (UNCITRAL) on reforms to investor–state dispute settlement.

China has shown leadership on global climate change diplomacy, urging nations to remain committed to the Paris Agreement in the wake of the US decision to pull out, and has been an important interlocutor with the UK and the EU on these issues. As a strong supporter of the Paris Agreement, but also as the world’s top emitter of carbon dioxide, China has a crucial role to play in pushing forward implementation of the Paris targets. Despite its high emissions, China remains one of the few major economies on track to meet its targets,[3] giving it greater leverage to peer review other parties’ efforts.

A recent report by the UK parliament’s Foreign Affairs Committee (FAC), on China and the rules-based international order, noted that where a body of trust and goodwill is developed with China, there is the possibility of discovering interests that coincide and the ability to work together on issues mutually regarded as of global importance. The report refers to a number of success stories from UK partnership with China in multilateral forums, including in counterproliferation and global health.[4]

Developing areas of global governance

As well as working with the current system, China is increasingly involved in the shaping of newer areas of international law – whether it be submissions to the International Tribunal for the Law of the Sea (ITLOS) on procedural rules for the emerging deep-sea mining regime or pitching for a greater role in Arctic governance.[5]

This enthusiasm should be harnessed to promote the international rule of law, but at the same time there needs to be recognition of the strategic goals that drive China’s engagement. China’s interest in the Arctic, while including the desire to protect its ecology and environment, is also about access to marine resources, as well as about the Arctic’s strategic potential for China’s military.

China’s submissions to ITLOS on the rules of procedure for deep-sea mining are constructive, but also reflect an ambition to secure first-mover advantage when commercial mining eventually takes place. Like other major powers working in this policy area, China’s actions are guided by self-interest, but that doesn’t mean its goals can’t be pursued through multilateral rules.

China is also interested in creating new international structures and instruments that further its strategic aims. For example, with Russia (through the Shanghai Cooperation Organisation) it has proposed an International Code of Conduct for Information Security in the UN.[6]

China is also pondering an array of options for dispute-resolution mechanisms for its Belt and Road projects, including the possibility of an Asian version of the international Convention on the Settlement of Investment Disputes, which might sit under the auspices of the Asian Infrastructure Investment Bank (AIIB).[7]

The creation of new instruments and institutions need not be a threat to the rules-based international order in itself. We have already seen a combination of the creation of parallel complementary regimes alongside the reform of existing institutions, for example in development financing through the AIIB or the New Development Bank (often referred to as the ‘BRICS Bank’); these two banks are relatively conventionally structured along the lines of Western-dominated institutions, albeit with greater Chinese control. Based on these examples, selective adaptation seems more likely than a hostile ‘Eastphalian’ takeover.[8]

Risks

There is, however, a real risk that in certain areas China may promote a rival authoritarian model of governance, assisted by an opportunistic convergence with Russia on issues such as human rights, development and internet governance. In areas where China’s core interests clash with those of the rules-based international order, China has shown itself to be unbending, as in its refusal to abide by the July 2016 decision of the Permanent Court of Arbitration in its dispute with the Philippines over the South China Sea.[9]

China is becoming more assertive at the UN, but while it seeks to project itself there as a responsible emerging global leader, it is promoting a vision that weakens international norms of human rights, transparency and accountability,[10] while also carrying out practices domestically that raise serious human rights concerns (not least the detention of hundreds of thousands of Uighurs in re-education camps in Xinjiang).[11]

China’s increased dominance geographically and geopolitically through its Belt and Road infrastructure projects carries with it a number of social and economic risks, including smaller states becoming trapped in unsustainable financial debts to China.

But at a recent Chatham House conference on Asia and international law, participants highlighted the limitations on how far China can shape an alternative governance model.[12] China currently lacks soft power, cultural power and language power, all of which are needed in order to embed an alternative model abroad. China also currently lacks capacity and confidence to build coalitions with other states in the UN.

Where it has tried to get buy-in from the international community for its new institutions, such as the China International Commercial Court (CICC) announced in July 2018, there has been scepticism about the standards to be applied.[13] Unless the court can demonstrate sufficient due process, international parties are likely to prefer other centres with a strong reputation for upholding the rule of law, such as those in London, Dubai and Singapore.

Where China does promote its own governance model at the expense of the rules-based international order, states are starting to push back, often in concert. EU member states so far have adopted a joined-up approach to the Belt and Road Initiative. With the exception of Italy, they have refused to sign a Memorandum of Understanding on participation unless China provides much greater transparency on its compliance with international standards.

The EU also recently presented a coordinated response to China on the situation in Xinjiang.[14] Similarly, members of the so-called ‘Five Eyes’ intelligence-sharing alliance (comprising Australia, Canada, New Zealand, the UK and the US) have acted together in relation to certain incidents of cyber interference attributed to China.[15]

There are also signs of pushback from smaller states closer to home in relation to challenges to national sovereignty, debt diplomacy and financial viability arising from Belt and Road projects. The Sri Lankan government recently reversed the award of a $300 million housing deal to China, instead opting for a joint venture with an Indian company.

China has been downscaling its investments as a way to counter some of the backlash it has received: the most recent Belt and Road summit put forward a more modest set of aspirations. This suggests that there is some scope for states to stand up to China and use leverage to secure better deals.

Many international institutions have been Western-dominated for years;[16] China, together with many emerging and middle powers, has felt for some time that the international architecture does not reflect the world we live in. Given that context, states that champion the rules-based international order should acknowledge China’s desire to update the international order to reflect greater multipolarity, globalization and technological change, while being clear-eyed about their engagement with China. This involves investing in a proper understanding of China and how it works.[17]

Where possible, cooperation with China should lead to outcomes that are backed up by international standards and transparency. The above-mentioned FAC report cites evidence that the UK’s support, and that of other developed countries, had a positive impact in shaping the governance and standards of the AIIB.[18] China has brought in international experts to advise on disputes before the CIIC, which may reassure would-be litigants.

China’s relationship with the rules-based international order needs to be assessed pragmatically and dynamically. China can be a valuable partner in many areas where its objectives are closely aligned with those of the international community – from trade to climate change to peacekeeping.

But where the country’s core interests are at odds with those of the wider international community, an increasingly confident China will strongly resist pressure, including on the South China Sea and human rights. In these areas, states supportive of international law can most powerfully push back through alliances and by ensuring that their own core values are not compromised in the interests of economic benefits.

What needs to happen

  • China’s rising power and selective commitment to multilateralism make it a potentially influential ally in modernizing international governance.
  • China is increasingly involved in shaping newer areas of international law. This enthusiasm could be harnessed in the service of institutional development and reform.
  • Other states should identify areas of mutual strategic interest where China may offer a constructive role, including dispute settlement, health and climate change.
  • However, engagement must not ignore the strategic calculations that drive China’s agenda, or its poor record on civil and political rights, transparency and accountability.
  • Cooperation with China should lead to outcomes that are backed up by international standards and transparency.
  • Where China’s actions undermine the rules-based international order, coordinated action by states supportive of that order is likely to be more effective than acting individually.

Notes

[1] Chalmers, M. (2019), Which Rules? Why There is No Single ‘Rules-Based International System’, RUSI Occasional Paper, April 2019, London: Royal United Services Institute, https://rusi.org/occasional-papers/Which-Rules-Why-There-Is-No-Single-Rules-Based-International-System.

[2] See, for example, Moynihan, H. (2017), China’s Evolving Approach to International Dispute Settlement, Briefing, London: Royal Institute of International Affairs, https://www.chathamhouse.org/publication/chinas-evolving-approach-international-dispute-settlement.

[3] UN Environment (2018), Emissions Gap Report 2018, p. XVII, https://www.unenvironment.org/resources/emissions-gap-report-2018.

[4] House of Commons Foreign Affairs Committee (2019), China and the Rules-Based International System: Sixteenth Report of Session 2017–19, p. 32, https://publications.parliament.uk/pa/cm201719/cmselect/cmfaff/612/612.pdf.

[5] Moynihan, H. (2018), ‘China Expands Its Global Governance Ambitions in the Arctic’, Expert Comment, 15 October 2018, https://www.chathamhouse.org/expert/comment/china-expands-its-global-governance-ambitions-arctic.

[6] Updated version proposed 9 January 2015.

[7] Moynihan, H. (2018), ‘Exploring Public International Law Issues with Chinese Scholars – Part Four’, Meeting Summary, 3 June 2018, https://www.chathamhouse.org/publication/exploring-public-international-law-issues-chinese-scholars-part-four.

[8] Chatham House (2019, forthcoming, ‘Security and Prosperity in the Asia-Pacific: The Role of International Law’, conference summary, https://www.chathamhouse.org/event/security-and-prosperity-asia-pacific-role-international-law.

[9] Permanent Court of Arbitration Case No. 2013-19 (Philippines v China), Award of 12 July 2016, https://pca-cpa.org/wp-content/uploads/sites/6/2016/07/PH-CN-20160712-Award.pdf.

[10] Piccone, T. (2018), China’s Long Game on Human Rights at the United Nations, Washington, DC: Brookings Institution, https://www.brookings.edu/wp-content/uploads/2018/09/FP_20181009_china_human_rights.pdf.

[11] Wye, R. (2018), ‘‘The entire Uyghur population is seemingly being treated as suspect’: China’s persecution of its Muslim minority’, LSE Religion and Global Society blog, 18 September 2018, https://blogs.lse.ac.uk/religionglobalsociety/2018/09/the-entire-uyghur-population-is-seemingly-being-treated-as-suspect-chinas-persecution-of-its-muslim-minority/.

[12] Chatham House (2019, forthcoming, ‘Security and Prosperity in the Asia-Pacific: The Role of International Law’.

[13] Walters, M. (2018), ‘Jury is out over China’s new commercial court, say lawyers’, Law Society Gazette, 1 November 2018, https://www.lawgazette.co.uk/law/jury-is-out-over-chinas-new-commercial-court-say-lawyers/5068125.article.

[14] The Economist (2019), ‘Hope remains for Western solidarity. Look at embassies in Beijing’, 17 April 2019, https://www.economist.com/china/2019/04/20/hope-remains-for-western-solidarity-look-at-embassies-in-beijing.

[15] In December 2018, the Five Eyes attributed the activities of a Chinese cyber espionage group targeting intellectual property and sensitive commercial property to China’s Ministry of State Security.

[16] Roberts, A. (2017), Is International Law International?, Oxford: Oxford University Press.

[17] Parton, C. (2019), China–UK Relations: Where to Draw the Border Between Influence and Interference?, RUSI Occasional Paper, February 2019, London: Royal United Services Institute, p. 30, https://rusi.org/publication/occasional-papers/china-uk-relations-where-draw-border-between-influence-and.

[18] House of Commons Foreign Affairs Committee (2019), China and the Rules-Based International System, p. 15.

This essay was produced for the 2019 edition of Chatham House Expert Perspectives – our annual survey of risks and opportunities in global affairs – in which our researchers identify areas where the current sets of rules, institutions and mechanisms for peaceful international cooperation are falling short, and present ideas for reform and modernization.




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Lebanon Is Paying the Cost of Its Dysfunctional Politics

26 February 2020

Nadim Shehadi

Associate Fellow, Middle East and North Africa Programme
A series of fights to political stalemate have led its economy to the brink and cut it off from its natural economic partners in the Gulf.

2020-02-25-Leb1.jpg

Protests against economic conditions and government inaction turned violent in January. Photo: Getty Images.

To understand Lebanon’s financial collapse, look to its politics.

The country has been deeply damaged by an increasingly dysfunctional political system. A series of compromises have alienated it from its main markets in the Gulf and strangled its economy; anyone that has glanced at fluctuations in Lebanese bank deposits over the last 10 years can see the correlation.

Imagine if Boris Johnson or Donald Trump were obliged to form joint governments with Jeremy Corbyn or Bernie Sanders. The result would be paralysis and lack of accountability as each party pulls the country in opposite directions and blames the other for the state of limbo. This has been the state of affairs in Lebanon since the Doha agreement of 2008. 

That agreement followed an 18-month siege that paralyzed Beirut and an attack on the city by Hezbollah’s ‘black shirts’. The Doha formula imposed governments of national unity between Prime Minister Saad Hariri’s pro-Saudi camp and Hezbollah’s pro-Iran camp and their respective internal allies.

The pattern was set: each period of subsequent paralysis was followed by further compromise as the tug of war pulled the country away from its principal economic partners, the Arab Gulf states, with the regional balance of power tilting towards Hezbollah. 

It was not supposed to be like this. The Baabda Declaration in June 2012, reached after a process of national dialogue, was meant to secure Lebanon’s neutrality in regional conflicts, with both sides promising to hold back on external alliances and coexist despite difference over major regional issues like the war in Syria, the standoff between the US and Iran or relations with Israel or the Gulf states.

This has worn away. The Baabda declaration itself became a sham when Hezbollah inserted itself into the war in Syria in support of the Assad regime and overtly got involved in Iraq and Yemen as an Iranian proxy. This was followed by Saudi opposition to concessions by Hariri that led to the election of General Michel Aoun, an ally of Hezbollah, as president in October 2016; again, after a political paralysis that lasted 29 months with no active government and no head of state.  

The Saudis were also furious when President Aoun’s son-in-law, Foreign Minister Gebran Bassil, abstained from condemning the burning of the Saudi embassy in Tehran at an Arab League meeting in Cairo in January 2016, citing the need to preserve national unity.

Fearing that he was simply providing Hezbollah with protection in the guise of compromise, the Saudis pressured Hariri to resign in November 2017 during a trip to Riyadh, but he later challenged that by retracting on his resignation when back in Beirut. Lebanon was caught between two sides, and as the regional conflict intensified from tension to open confrontation, neutrality was no longer an option.

Gulf connections

An estimated 350,000 Lebanese expats live and work in Saudi Arabia, the UAE, Qatar and Kuwait. These countries are also the main clients for Lebanese contractors, consultants and advertising companies, some of which have offices there. The domestic tourism industry relies heavily on Arab Gulf visitors and they are a principal source of foreign investments especially in the real estate sector.

Lebanon also enjoyed a certain degree of political and economic protection from the US and the Gulf, and Hezbollah benefited indirectly from that protection, as it also shielded it to a certain degree from sanctions.

The deterioration of relations meant that the country was cut off by its Gulf partners. This was manifested in travel bans for Gulf Cooperation Council (GCC) nationals to Lebanon and a decrease in investments and bank deposits, as well as a decrease in remittances from Lebanese expats, partly because of economic crisis in the Gulf countries themselves.

Saudi Arabia withdrew $4 billion of aid to the Lebanese army and internal security forces, and no aid or deposits were forthcoming as the economic and financial situation deteriorated. 

The costs to the Lebanese economy include the opportunity cost created by the annual threat of war with Israel, after which trips are cancelled and projects postponed. Hezbollah also controls a section of Beirut port where it pays no duty or taxes. Add to that the economic fallout from the war in Syria, such as the impact on exports, the inflow of refugees and the cost of Hezbollah’s involvement.

The burden of these political factors is difficult to estimate but it constitutes the ransom that the Lebanese economy bears as a cost of the compromise. This is not to absolve Lebanese politicians from corruption or bankers of mismanagement but to add that political factors cannot be ignored.

The cumulative cost and economic impact of being cut off from its main economic partner eventually bankrupted the country. The fiscal and financial aspects, with Lebanon’s inability to service its debt, are but a reflection of these political factors. In the long run, the key to avoiding complete collapse is to restore relations with the GCC and free Lebanon from that very costly grip.




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Digital government could become just more cost cutting, warns Internet Australia

Revolving door at digital agency must stop, says Labor.




cost

Engage China to Uphold Multilateralism – But Not at Any Cost

12 June 2019

Harriet Moynihan

Senior Research Fellow, International Law Programme
Where China’s interests align with those of the international community, there are opportunities for the country’s influence and economic power to strengthen the rules-based international order. Where they do not, states that traditionally support that order should join together to push back.

2019-02-01-China.jpg

Students holding Chinese national flags watch the live broadcast of the 40th anniversary celebration of China's reform and opening-up at Huaibei Normal University on 18 December. Photo: Getty Images.

China’s adherence to the rules-based international system is selective, prioritizing certain rules in favour of others. States supportive of that ‘system’ – or, as some argue, systems[1] – should identify areas of mutual strategic interest so that they can draw China further into the global rules-based order and leverage China as a constructive player that potentially also contributes to improvements in such areas. This is particularly apposite at a time when the US is in retreat from multilateralism and Russia seems bent on disrupting the rules-based international order.

Supportive player

There are many reasons for actively engaging with China on mutual areas of interest. China is a committed multilateralist in many areas, recognizing that often international cooperation and frameworks hold the key to its domestic problems, for example in the fields of environmental sustainability and financial regulation.

China’s economic power is valuable in upholding international institutions: China is the UN’s third-largest donor (after the US and Japan) at a time when the UN is facing budgetary shortfalls. China is also the second-highest contributor to the UN peacekeeping budget, and the largest contributor of peacekeeping forces among the five permanent members of the UN Security Council.

China also has a valuable role to play in the settlement of international disputes over trade and investment. China is a big supporter of the World Trade Organization (WTO)’s dispute settlement mechanism, and one of its most active participants;[2] China is currently playing an active role in negotiations to save the WTO’s appellate mechanism from folding in the wake of the US’s refusal to nominate new judges.

The last 15 years have also seen a major shift in Chinese attitudes to investment arbitration, from a general suspicion and limitation of arbitration rights to broad acceptance and incorporation of such rights in China’s trade and investment treaties. China is actively engaged in multilateral negotiations through the UN Commission on International Trade Law (UNCITRAL) on reforms to investor–state dispute settlement.

China has shown leadership on global climate change diplomacy, urging nations to remain committed to the Paris Agreement in the wake of the US decision to pull out, and has been an important interlocutor with the UK and the EU on these issues. As a strong supporter of the Paris Agreement, but also as the world’s top emitter of carbon dioxide, China has a crucial role to play in pushing forward implementation of the Paris targets. Despite its high emissions, China remains one of the few major economies on track to meet its targets,[3] giving it greater leverage to peer review other parties’ efforts.

A recent report by the UK parliament’s Foreign Affairs Committee (FAC), on China and the rules-based international order, noted that where a body of trust and goodwill is developed with China, there is the possibility of discovering interests that coincide and the ability to work together on issues mutually regarded as of global importance. The report refers to a number of success stories from UK partnership with China in multilateral forums, including in counterproliferation and global health.[4]

Developing areas of global governance

As well as working with the current system, China is increasingly involved in the shaping of newer areas of international law – whether it be submissions to the International Tribunal for the Law of the Sea (ITLOS) on procedural rules for the emerging deep-sea mining regime or pitching for a greater role in Arctic governance.[5]

This enthusiasm should be harnessed to promote the international rule of law, but at the same time there needs to be recognition of the strategic goals that drive China’s engagement. China’s interest in the Arctic, while including the desire to protect its ecology and environment, is also about access to marine resources, as well as about the Arctic’s strategic potential for China’s military.

China’s submissions to ITLOS on the rules of procedure for deep-sea mining are constructive, but also reflect an ambition to secure first-mover advantage when commercial mining eventually takes place. Like other major powers working in this policy area, China’s actions are guided by self-interest, but that doesn’t mean its goals can’t be pursued through multilateral rules.

China is also interested in creating new international structures and instruments that further its strategic aims. For example, with Russia (through the Shanghai Cooperation Organisation) it has proposed an International Code of Conduct for Information Security in the UN.[6]

China is also pondering an array of options for dispute-resolution mechanisms for its Belt and Road projects, including the possibility of an Asian version of the international Convention on the Settlement of Investment Disputes, which might sit under the auspices of the Asian Infrastructure Investment Bank (AIIB).[7]

The creation of new instruments and institutions need not be a threat to the rules-based international order in itself. We have already seen a combination of the creation of parallel complementary regimes alongside the reform of existing institutions, for example in development financing through the AIIB or the New Development Bank (often referred to as the ‘BRICS Bank’); these two banks are relatively conventionally structured along the lines of Western-dominated institutions, albeit with greater Chinese control. Based on these examples, selective adaptation seems more likely than a hostile ‘Eastphalian’ takeover.[8]

Risks

There is, however, a real risk that in certain areas China may promote a rival authoritarian model of governance, assisted by an opportunistic convergence with Russia on issues such as human rights, development and internet governance. In areas where China’s core interests clash with those of the rules-based international order, China has shown itself to be unbending, as in its refusal to abide by the July 2016 decision of the Permanent Court of Arbitration in its dispute with the Philippines over the South China Sea.[9]

China is becoming more assertive at the UN, but while it seeks to project itself there as a responsible emerging global leader, it is promoting a vision that weakens international norms of human rights, transparency and accountability,[10] while also carrying out practices domestically that raise serious human rights concerns (not least the detention of hundreds of thousands of Uighurs in re-education camps in Xinjiang).[11]

China’s increased dominance geographically and geopolitically through its Belt and Road infrastructure projects carries with it a number of social and economic risks, including smaller states becoming trapped in unsustainable financial debts to China.

But at a recent Chatham House conference on Asia and international law, participants highlighted the limitations on how far China can shape an alternative governance model.[12] China currently lacks soft power, cultural power and language power, all of which are needed in order to embed an alternative model abroad. China also currently lacks capacity and confidence to build coalitions with other states in the UN.

Where it has tried to get buy-in from the international community for its new institutions, such as the China International Commercial Court (CICC) announced in July 2018, there has been scepticism about the standards to be applied.[13] Unless the court can demonstrate sufficient due process, international parties are likely to prefer other centres with a strong reputation for upholding the rule of law, such as those in London, Dubai and Singapore.

Where China does promote its own governance model at the expense of the rules-based international order, states are starting to push back, often in concert. EU member states so far have adopted a joined-up approach to the Belt and Road Initiative. With the exception of Italy, they have refused to sign a Memorandum of Understanding on participation unless China provides much greater transparency on its compliance with international standards.

The EU also recently presented a coordinated response to China on the situation in Xinjiang.[14] Similarly, members of the so-called ‘Five Eyes’ intelligence-sharing alliance (comprising Australia, Canada, New Zealand, the UK and the US) have acted together in relation to certain incidents of cyber interference attributed to China.[15]

There are also signs of pushback from smaller states closer to home in relation to challenges to national sovereignty, debt diplomacy and financial viability arising from Belt and Road projects. The Sri Lankan government recently reversed the award of a $300 million housing deal to China, instead opting for a joint venture with an Indian company.

China has been downscaling its investments as a way to counter some of the backlash it has received: the most recent Belt and Road summit put forward a more modest set of aspirations. This suggests that there is some scope for states to stand up to China and use leverage to secure better deals.

Many international institutions have been Western-dominated for years;[16] China, together with many emerging and middle powers, has felt for some time that the international architecture does not reflect the world we live in. Given that context, states that champion the rules-based international order should acknowledge China’s desire to update the international order to reflect greater multipolarity, globalization and technological change, while being clear-eyed about their engagement with China. This involves investing in a proper understanding of China and how it works.[17]

Where possible, cooperation with China should lead to outcomes that are backed up by international standards and transparency. The above-mentioned FAC report cites evidence that the UK’s support, and that of other developed countries, had a positive impact in shaping the governance and standards of the AIIB.[18] China has brought in international experts to advise on disputes before the CIIC, which may reassure would-be litigants.

China’s relationship with the rules-based international order needs to be assessed pragmatically and dynamically. China can be a valuable partner in many areas where its objectives are closely aligned with those of the international community – from trade to climate change to peacekeeping.

But where the country’s core interests are at odds with those of the wider international community, an increasingly confident China will strongly resist pressure, including on the South China Sea and human rights. In these areas, states supportive of international law can most powerfully push back through alliances and by ensuring that their own core values are not compromised in the interests of economic benefits.

What needs to happen

  • China’s rising power and selective commitment to multilateralism make it a potentially influential ally in modernizing international governance.
  • China is increasingly involved in shaping newer areas of international law. This enthusiasm could be harnessed in the service of institutional development and reform.
  • Other states should identify areas of mutual strategic interest where China may offer a constructive role, including dispute settlement, health and climate change.
  • However, engagement must not ignore the strategic calculations that drive China’s agenda, or its poor record on civil and political rights, transparency and accountability.
  • Cooperation with China should lead to outcomes that are backed up by international standards and transparency.
  • Where China’s actions undermine the rules-based international order, coordinated action by states supportive of that order is likely to be more effective than acting individually.

Notes

[1] Chalmers, M. (2019), Which Rules? Why There is No Single ‘Rules-Based International System’, RUSI Occasional Paper, April 2019, London: Royal United Services Institute, https://rusi.org/occasional-papers/Which-Rules-Why-There-Is-No-Single-Rules-Based-International-System.

[2] See, for example, Moynihan, H. (2017), China’s Evolving Approach to International Dispute Settlement, Briefing, London: Royal Institute of International Affairs, https://www.chathamhouse.org/publication/chinas-evolving-approach-international-dispute-settlement.

[3] UN Environment (2018), Emissions Gap Report 2018, p. XVII, https://www.unenvironment.org/resources/emissions-gap-report-2018.

[4] House of Commons Foreign Affairs Committee (2019), China and the Rules-Based International System: Sixteenth Report of Session 2017–19, p. 32, https://publications.parliament.uk/pa/cm201719/cmselect/cmfaff/612/612.pdf.

[5] Moynihan, H. (2018), ‘China Expands Its Global Governance Ambitions in the Arctic’, Expert Comment, 15 October 2018, https://www.chathamhouse.org/expert/comment/china-expands-its-global-governance-ambitions-arctic.

[6] Updated version proposed 9 January 2015.

[7] Moynihan, H. (2018), ‘Exploring Public International Law Issues with Chinese Scholars – Part Four’, Meeting Summary, 3 June 2018, https://www.chathamhouse.org/publication/exploring-public-international-law-issues-chinese-scholars-part-four.

[8] Chatham House (2019, forthcoming, ‘Security and Prosperity in the Asia-Pacific: The Role of International Law’, conference summary, https://www.chathamhouse.org/event/security-and-prosperity-asia-pacific-role-international-law.

[9] Permanent Court of Arbitration Case No. 2013-19 (Philippines v China), Award of 12 July 2016, https://pca-cpa.org/wp-content/uploads/sites/6/2016/07/PH-CN-20160712-Award.pdf.

[10] Piccone, T. (2018), China’s Long Game on Human Rights at the United Nations, Washington, DC: Brookings Institution, https://www.brookings.edu/wp-content/uploads/2018/09/FP_20181009_china_human_rights.pdf.

[11] Wye, R. (2018), ‘‘The entire Uyghur population is seemingly being treated as suspect’: China’s persecution of its Muslim minority’, LSE Religion and Global Society blog, 18 September 2018, https://blogs.lse.ac.uk/religionglobalsociety/2018/09/the-entire-uyghur-population-is-seemingly-being-treated-as-suspect-chinas-persecution-of-its-muslim-minority/.

[12] Chatham House (2019, forthcoming, ‘Security and Prosperity in the Asia-Pacific: The Role of International Law’.

[13] Walters, M. (2018), ‘Jury is out over China’s new commercial court, say lawyers’, Law Society Gazette, 1 November 2018, https://www.lawgazette.co.uk/law/jury-is-out-over-chinas-new-commercial-court-say-lawyers/5068125.article.

[14] The Economist (2019), ‘Hope remains for Western solidarity. Look at embassies in Beijing’, 17 April 2019, https://www.economist.com/china/2019/04/20/hope-remains-for-western-solidarity-look-at-embassies-in-beijing.

[15] In December 2018, the Five Eyes attributed the activities of a Chinese cyber espionage group targeting intellectual property and sensitive commercial property to China’s Ministry of State Security.

[16] Roberts, A. (2017), Is International Law International?, Oxford: Oxford University Press.

[17] Parton, C. (2019), China–UK Relations: Where to Draw the Border Between Influence and Interference?, RUSI Occasional Paper, February 2019, London: Royal United Services Institute, p. 30, https://rusi.org/publication/occasional-papers/china-uk-relations-where-draw-border-between-influence-and.

[18] House of Commons Foreign Affairs Committee (2019), China and the Rules-Based International System, p. 15.

This essay was produced for the 2019 edition of Chatham House Expert Perspectives – our annual survey of risks and opportunities in global affairs – in which our researchers identify areas where the current sets of rules, institutions and mechanisms for peaceful international cooperation are falling short, and present ideas for reform and modernization.




cost

Mark Ricketts | Time to rethink economic implications - Jamaica engages IMF but the cost of the pandemic remains high

On Tuesday, April 14, the International Monetary Fund downgraded Jamaica’s growth prospects to -5.6 per cent. This is a severe contraction warranting substantial Government intervention. However, at times, the Government waits too late to respond...




cost

Nigel Crisp - The NHS isn't just a cost to society, it's a benefit

If you google "The NHS" you'll see screaming headlines from the Daily Mail about cost and waste - debate in parliament is about how much of our GDP we should be spending - and each year, hospital trusts go cap in hand to ask for more funding. Against this backdrop, a new analysis, and a first in a series, published on bmj.com, looks at what it...




cost

Telephone consultations - no cost savings, but increased GP workload

If you're a patient in the UK, increasingly, your first interaction with the healthcare system won't be the traditional face to fact chat with your doctor - instead you'll have a telephone consultation. The prevalence of these telephone consultations is increasing, and being promoted by CCGs and private companies who administer them - usually as...




cost

Don't save on transport at the cost of the NHS

Last week we heard about how evidence in policy making is imperilled - but today we’re hearing about a plan to make evidence about health central to all aspects of government. Laura Webber, director of public health modelling at the UK Health Forum, Susie Morrow, chair of the Wandsworth Living Streets Group and Brian Ferguson, chief economist at...




cost

Doctors as Taxi Drivers: The Costs of Brain Waste among Highly Skilled Immigrants in the United States

A report release and presentation of first-ever U.S. estimates on the actual economic costs of skill underutilization for immigrants, their families, and the U.S. economy, in terms of forgone earnings and unrealized federal, state, and local taxes.




cost

Within-Trial Evaluation of Medical Resources, Costs, and Quality of Life Among Patients With Type 2 Diabetes Participating in the Exenatide Study of Cardiovascular Event Lowering (EXSCEL)

OBJECTIVE

To compare medical resource use, costs, and health utilities for 14,752 patients with type 2 diabetes who were randomized to once-weekly exenatide (EQW) or placebo in addition to usual diabetes care in the Exenatide Study of Cardiovascular Event Lowering (EXSCEL).

RESEARCH DESIGN AND METHODS

Medical resource use data and responses to the EuroQol 5-Dimension (EQ-5D) instrument were collected at baseline and throughout the trial. Medical resources and medications were assigned values by using U.S. Medicare payments and wholesale acquisition costs, respectively. Secondary analyses used English costs.

RESULTS

Patients were followed for an average of 3.3 years, during which time those randomized to EQW experienced 0.41 fewer inpatient days (7.05 vs. 7.46 days; relative rate ratio 0.91; P = 0.05). Rates of outpatient medical visits were similar, as were total inpatient and outpatient costs. Mean costs for nonstudy diabetes medications over the study period were ~$1,600 lower with EQW than with placebo (P = 0.01). Total within-study costs, excluding study medication, were lower in the EQW arm than in the placebo arm ($28,907 vs. $30,914; P ≤ 0.01). When including the estimated cost of EQW, total mean costs were significantly higher in the EQW group than in the placebo group ($42,697 vs. $30,914; P < 0.01). With English costs applied, mean total costs, including exenatide costs, were £1,670 higher in the EQW group than the placebo group (£10,874 vs. £9,204; P < 0.01). There were no significant differences in EQ-5D health utilities between arms over time.

CONCLUSIONS

Medical costs were lower in the EQW arm than the placebo arm, but total costs were significantly higher once the cost of branded exenatide was incorporated.




cost

Impact of Treating Oral Disease on Preventing Vascular Diseases: A Model-Based Cost-effectiveness Analysis of Periodontal Treatment Among Patients With Type 2 Diabetes

OBJECTIVE

Previous randomized trials found that treating periodontitis improved glycemic control in patients with type 2 diabetes (T2D), thus lowering the risks of developing T2D-related microvascular diseases and cardiovascular disease (CVD). Some payers in the U.S. have started covering nonsurgical periodontal treatment for those with chronic conditions, such as diabetes. We sought to identify the cost-effectiveness of expanding periodontal treatment coverage among patients with T2D.

RESEARCH DESIGN AND METHODS

A cost-effectiveness analysis was conducted to estimate lifetime costs and health gains using a stochastic microsimulation model of oral health conditions, T2D, T2D-related microvascular diseases, and CVD of the U.S. population. Model parameters were obtained from the nationally representative National Health and Nutrition Examination Survey (NHANES) (2009–2014) and randomized trials of periodontal treatment among patients with T2D.

RESULTS

Expanding periodontal treatment coverage among patients with T2D and periodontitis would be expected to avert tooth loss by 34.1% (95% CI –39.9, –26.5) and microvascular diseases by 20.5% (95% CI –31.2, –9.1), 17.7% (95% CI –32.7, –4.7), and 18.4% (95% CI –34.5, –3.5) for nephropathy, neuropathy, and retinopathy, respectively. Providing periodontal treatment to the target population would be cost saving from a health care perspective at a total net savings of $5,904 (95% CI –6,039, –5,769) with an estimated gain of 0.6 quality-adjusted life years per capita (95% CI 0.5, 0.6).

CONCLUSIONS

Providing nonsurgical periodontal treatment to patients with T2D and periodontitis would be expected to significantly reduce tooth loss and T2D-related microvascular diseases via improved glycemic control. Encouraging patients with T2D and poor oral health conditions to receive periodontal treatment would improve health outcomes and still be cost saving or cost-effective.




cost

The Association Between Poor Glycemic Control and Health Care Costs in People With Diabetes: A Population-Based Study

OBJECTIVE

To analyze the differences in health care costs according to glycemic control in people with type 2 diabetes.

RESEARCH DESIGN AND METHODS

Data on health care resource utilization from 100,391 people with type 2 diabetes were extracted from the electronic database used at the Catalan Health Institute. Multivariate regression models were carried out to test the impact of glycemic control (HbA1c) on total health care, hospital admission, and medication costs; model 1 adjusted for a variety of covariates, and model 2 also included micro- and macrovascular complications. Glycemic control was classified as good for HbA1c <7%, fair for ≥7% to <8%, poor for ≥8% to <10%, and very poor for ≥10%.

RESULTS

Mean per patient annual direct medical costs were 3,039 ± SD 6,581. Worse glycemic control was associated with higher total health care costs: compared with good glycemic control, health care costs increased by 18% (509.82) and 23% (661.35) in patients with very poor and poor glycemic control, respectively, when unadjusted and by 428.3 and 395.1, respectively, in model 2. Medication costs increased by 12% in patients with fair control and by 28% in those with very poor control (model 2). Patients with poor control had a higher probability of hospitalization than those with good control (5% in model 2) and a greater average cost when hospitalization occurred (811).

CONCLUSIONS

Poor glycemic control was directly related to higher total health care, hospitalization, and medication costs. Preventive strategies and good glycemic control in people with type 2 diabetes could reduce the economic impact associated with this disease.




cost

Impact of a Telephonic Intervention to Improve Diabetes Control on Health Care Utilization and Cost for Adults in South Bronx, New York

OBJECTIVE

Self-management education and support are essential for improved diabetes control. A 1-year randomized telephonic diabetes self-management intervention (Bronx A1C) among a predominantly Latino and African American population in New York City was found effective in improving blood glucose control. To further those findings, this current study assessed the intervention’s impact in reducing health care utilization and costs over 4 years.

RESEARCH DESIGN AND METHODS

We measured inpatient (n = 816) health care utilization for Bronx A1C participants using an administrative data set containing all hospital discharges for New York State from 2006 to 2014. Multilevel mixed modeling was used to assess changes in health care utilization and costs between the telephonic diabetes intervention (Tele/Pr) arm and print-only (PrO) control arm.

RESULTS

During follow-up, excess relative reductions in all-cause hospitalizations for the Tele/Pr arm compared with PrO arm were statistically significant for odds of hospital use (odds ratio [OR] 0.89; 95% CI 0.82, 0.97; P < 0.01), number of hospital stays (rate ratio [RR] 0.90; 95% CI 0.81, 0.99; P = 0.04), and hospital costs (RR 0.90; 95% CI 0.84, 0.98; P = 0.01). Reductions in hospital use and costs were even stronger for diabetes-related hospitalizations. These outcomes were not significantly related to changes observed in hemoglobin A1c during individuals’ participation in the 1-year intervention.

CONCLUSIONS

These results indicate that the impact of the Bronx A1C intervention was not just on short-term improvements in glycemic control but also on long-term health care utilization. This finding is important because it suggests the benefits of the intervention were long-lasting with the potential to not only reduce hospitalizations but also to lower hospital-associated costs.




cost

Economic Costs of Diabetes in the U.S. in 2017

American Diabetes Association
May 1, 2018; 41:917-928
The Costs Of Diabetes




cost

Economic Costs of Diabetes in the U.S. in 2012

American Diabetes Association
Apr 1, 2013; 36:1033-1046
Scientific Statement




cost

The Cost of Diabetes Care--An Elephant in the Room

Matthew C. Riddle
May 1, 2018; 41:929-932
The Costs Of Diabetes




cost

Economic Costs of Diabetes in the U.S. in 2017

American Diabetes Association
May 1, 2018; 41:917-928
The Costs Of Diabetes




cost

Effect of Cost and Formulation on Persistence and Adherence to Initial Metformin Therapy for Type 2 Diabetes




cost

Cost and Cost-Effectiveness of Large-Scale Screening for Type 1 Diabetes in Colorado

OBJECTIVE

To assess the costs and project the potential lifetime cost-effectiveness of the ongoing Autoimmunity Screening for Kids (ASK) program, a large-scale, presymptomatic type 1 diabetes screening program for children and adolescents in the metropolitan Denver region.

RESEARCH DESIGN AND METHODS

We report the resource utilization, costs, and effectiveness measures from the ongoing ASK program compared with usual care (i.e., no screening). Additionally, we report a practical screening scenario by including utilization and costs relevant to routine screening in clinical practice. Finally, we project the potential cost-effectiveness of ASK and routine screening by identifying clinical benchmarks (i.e., diabetic ketoacidosis [DKA] events avoided, HbA1c improvements vs. no screening) needed to meet value thresholds of $50,000–$150,000 per quality-adjusted life-year (QALY) gained over a lifetime horizon.

RESULTS

Cost per case detected was $4,700 for ASK screening and $14,000 for routine screening. To achieve value thresholds of $50,000–$150,000 per QALY gained, screening costs would need to be offset by cost savings through 20% reductions in DKA events at diagnosis in addition to 0.1% (1.1 mmol/mol) improvements in HbA1c over a lifetime compared with no screening for patients who develop type 1 diabetes. Value thresholds were not met from avoiding DKA events alone in either scenario.

CONCLUSIONS

Presymptomatic type 1 diabetes screening may be cost-effective in areas with a high prevalence of DKA and an infrastructure facilitating screening and monitoring if the benefits of avoiding DKA events and improved HbA1c persist over long-run time horizons. As more data are collected from ASK, the model will be updated with direct evidence on screening effects.