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There has been an increasing interest in the relationship between severity of disease and costs in the care of people with dementia. Much of the current evidence is based on cross-sectional data, suggesting the need to examine trends over time for this important and growing cohort of the population.
This paper estimates resource use and costs of care based on longitudinal data for 72 people with dementia in Ireland. Data were collected from the Enhancing Care in Alzheimer's Disease (ECAD) study at two time points: baseline and follow-up, two years later. Patients’ dependence on others was measured using the Dependence Scale (DS), while patient function was measured using the Disability Assessment for Dementia (DAD) scale. Univariate and multivariate analysis were used to explore the effects of a range of variables on formal and informal care costs.
Total costs of formal and informal care over six months rose from €9,266 (Standard Deviation (SD): 12,947) per patient at baseline to €21,266 (SD: 26,883) at follow-up, two years later. This constituted a statistically significant (p = 0.0014) increase in costs over time, driven primarily by an increase in estimated informal care costs. In the multivariate analysis, a one-point increase in the DS score, that is a one-unit increase in patient's dependence on others, was associated with a 19% increase in total costs (p = 0.0610).
Higher levels of dependence in people with Alzheimer's disease are significantly associated with increased costs of informal care as the disease progresses. Formal care services did not respond to increased dependence in people with dementia, leaving it to families to fill the caring gap, mainly through increased supervision with the progress of disease.
The purpose of this book is to provide a detailed explanation of the history, principles, and legal terms of the WTO Customs Valuation Agreement and its associated legal texts, such as interpretative decisions of the WTO Committee on Customs Valuation. It is intended to instruct and serve as a reference for those who are new to, or have limited familiarity with, the Agreement. Expert users also may find it useful for reference purposes.
We have included test questions in this book to demonstrate the application of the Agreement to specific import scenarios. Our proposed answers to the questions, which can be found at the end of each chapter, are based on WTO and World Customs Organization (WCO) interpretative materials, as well as on rulings of various national customs administrations.
The WTO Valuation Agreement is fifteen years old at the time of writing. It is applied by the 153 WTO Members, representing all levels of economic development, to the full variety of their import trade transactions. If one takes into account the predecessor GATT Valuation Code, these valuation rules have been in use in international practice for over thirty years. What then do WTO Members think of the Agreement? What are its major failings, if there are any, and what improvements can be made? What is the future for common customs valuation rules?
A DEVELOPING–DEVELOPED COUNTRY DIVIDE?
Perhaps the main doubt about the WTO customs valuation system, which has been present from the time of the negotiation of the Tokyo Round Code in the late 1970s, is whether it adequately accommodates the needs of the developing and least-developed countries. As described in previous chapters, the main changes that have been made to the Agreement or its predecessor GATT Valuation Code were originated by developing countries, and were driven by a concern that the Agreement did not give these countries sufficient tools to protect themselves against importer fraud, which affects developing countries disproportionately because of their typically higher duty rates and greater dependency on customs for government revenue. Thus, in the Tokyo Round negotiations, developing countries successfully included the Protocol to the Agreement on Implementation of Article VII, to allow the use of minimum price systems to continue for a transition period, among other protections. In the Uruguay Round negotiations, Members agreed to the Decision Regarding Cases Where Customs Administrations Have Reasons to Doubt the Truth or Accuracy of the Declared Value to clarify the balance of proof between customs and the importer, where fraud is suspected. And in more recent years, developing countries have proposed various changes to the Agreement to deal with fraud, such as binding rules for the exchange of information between national customs authorities to validate an importer’s declared value.
This guide to the WTO Customs Valuation Agreement is based on the authors' experiences of teaching its finer points to customs officials and policy-makers around the world. Covering the methods of valuation and the provisions on enforcement, implementation and dispute settlement, the authors give practical examples, explain interpretative decisions of national and international customs bodies, and analyse the history of its negotiation. Written as a learning tool, it helps both new and experienced policy-makers, customs officials, importers and exporters to gain a deeper understanding of the Agreement's function and aims.
1. The primary basis for customs value under this Agreement is “transaction value” as defined in Article 1. Article 1 is to be read together with Article 8 which provides, inter alia, for adjustments to the price actually paid or payable in cases where certain specific elements which are considered to form a part of the value for customs purposes are incurred by the buyer but are not included in the price actually paid or payable for the imported goods. Article 8 also provides for the inclusion in the transaction value of certain considerations which may pass from the buyer to the seller in the form of specified goods or services rather than in the form of money. Articles 2 through 7 provide methods of determining the customs value whenever it cannot be determined under the provisions of Article 1.
2. Where the customs value cannot be determined under the provisions of Article 1 there should normally be a process of consultation between the customs administration and importer with a view to arriving at a basis of value under the provisions of Article 2 or 3. It may occur, for example, that the importer has information about the customs value of identical or similar imported goods which is not immediately available to the customs administration in the port of importation. On the other hand, the customs administration may have information about the customs value of identical or similar imported goods which is not readily available to the importer. A process of consultation between the two parties will enable information to be exchanged, subject to the requirements of commercial confidentiality, with a view to determining a proper basis of value for customs purposes.
3. Articles 5 and 6 provide two bases for determining the customs value where it cannot be determined on the basis of the transaction value of the imported goods or of identical or similar imported goods. Under paragraph 1 of Article 5 the customs value is determined on the basis of the price at which the goods are sold in the condition as imported to an unrelated buyer in the country of importation. The importer also has the right to have goods which are further processed after importation valued under the provisions of Article 5 if the importer so requests. Under Article 6 the customs value is determined on the basis of the computed value. Both these methods present certain difficulties and because of this the importer is given the right, under the provisions of Article 4, to choose the order of application of the two methods.