{"edition":"usa","organization":"Remote Area Medical","organizationId":"org:remote-area-medical","boundaryVersion":"USA-50-states-DC-v1","updated":"2026-10-02","display":{"metric":{"id":"daly-equivalent","years":1,"label":"DALY","priceLabel":"$ / DALY"},"priceUSD":525515.351704092,"canonicalPriceUSDPerTenEquivalentYears":5255153.5170409195,"conversion":"display only; QALYs and income equivalents are not measured clinical DALYs"},"listDisplay":{"metric":{"id":"daly-equivalent","years":1,"label":"DALY","priceLabel":"$ / DALY"},"priceUSD":525515.351704092,"canonicalPriceUSDPerTenEquivalentYears":5255153.5170409195,"conversion":"display only; QALYs and income equivalents are not measured clinical DALYs"},"model":{"version":"usa-ram-health-resources-reconsidered-2026-10-02","costScope":"Ordinary national donor support, all non-volunteer functions and foreign support retained. Full donor numerator prices finite selected clinical/resource paths, not identified whole-portfolio return. Gross institutional resources are separate; household cash losses stay in welfare.","geographicAttribution":"g=.98 applies once to health and each signed receiving/volunteer resource flow. US-location service counts are not measured residence; all national expenses retained. No global patient share applied to vision-only output.","formula":"N=min(G*b/c,capacity); distinct=N*uniqueShare; base vision/dental/medical visitors partition distinct people, medical overlay overlaps vision/dental. Meaningful completed and additional cohorts separately apply severity, completion, purchaser and unmet fractions. Clinical integrates discounted gross utility with mortality/loss/alternative care and subtracts incremental harms. Joint household care/Rx states net simultaneous cash before signed logarithmic welfare; timed upkeep/earnings use separate flows. Combined=health+resources; positive known donor price=10*G/combined.","counterfactual":"Committed existing funding, clinicians, hosts, paid/free alternatives and subsequent access remain without the gift. Otherwise purchasers and equivalent free care have no incremental matched treatment benefit/harm; extra access attempts can still incur harm and cash. Screening/referral is not automatic completed care.","attribution":"One extra attendance is not a deduplicated person, household or treatment. DentalORvision base pathways are disjoint on one modeled visit, medical overlays share trip; repeated attendance carries no extra clinical/earnings stream. Positive earnings overlap is separate; all losses fully debit. Common-alive earnings are not survival-created income.","uncertainty":"All causal throughput, utility, completion, visitor/counterfactual/household mapping, residence, net cash and earnings priors are judgments. T is a clinical accounting window, not abrupt end of all functioning. Upkeep is persistent net incremental care-induced cash after later alternatives; its assumed incidence is not observed. Known capacity0 overrides funding unknown; supplied b is unavailable when fundingKnown false. Nonzero medical wages/upkeep unsupported until overlay paths are implemented. Unpriced branches remain unknown; fixed limits are not donation room.","nativeOutcomes":"Native 2025 US-location data: 25,383 patients, 7,999 eye exams and 15,013 glasses; teeth/encounters are different units. Central $10K comparison models 8 attendances, 7.2 distinct clinical people, 0.47 additional vision corrections, 0.83 dental episodes and 0.23 acute medical episodes. Health .028388425278921235 plus resources −.00935948546284748 yields .019028939816073755 combined equivalents.","inputs":[{"name":"G","value":10000,"unit":"USD normalization","basis":"judgment","rationale":"Explicit marginal/household/scope prior or discount convention; not observed causal input.","sourceIds":["ram-faq","ram-audit25","ram-income-method"]},{"name":"c","value":500,"unit":"USD full support per attendance","basis":"judgment","rationale":"Explicit marginal/household/scope prior or discount convention; not observed causal input.","sourceIds":["ram-faq","ram-audit25","ram-income-method"]},{"name":"b","value":0.4,"unit":"parameter units described in report","basis":"judgment","rationale":"Explicit marginal/household/scope prior or discount convention; not observed causal input.","sourceIds":["ram-faq","ram-audit25","ram-income-method"]},{"name":"capacity","value":20,"unit":"parameter units described in report","basis":"judgment","rationale":"Fixed conditional comparison limit, 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negative and unknown outcomes are distinct."},{"label":"medicalNull","pricePer10":5613353.0327727655,"assumptions":"Finite judged diagnostic, not a confidence interval; negative and unknown outcomes are distinct."},{"label":"resourceUnknown","pricePer10":null,"assumptions":"Finite judged diagnostic, not a confidence interval; negative and unknown outcomes are distinct."},{"label":"fundingUnknown","pricePer10":null,"assumptions":"Finite judged diagnostic, not a confidence interval; negative and unknown outcomes are distinct."},{"label":"visionUnknown","pricePer10":null,"assumptions":"Finite judged diagnostic, not a confidence interval; negative and unknown outcomes are distinct."},{"label":"dentalUnknown","pricePer10":null,"assumptions":"Finite judged diagnostic, not a confidence interval; negative and unknown outcomes are distinct."},{"label":"medicalUnknown","pricePer10":null,"assumptions":"Finite judged diagnostic, not a confidence interval; negative and unknown outcomes are distinct."},{"label":"negativeEarnings","pricePer10":6236387.035192865,"assumptions":"Finite judged diagnostic, not a confidence interval; negative and unknown outcomes are distinct."},{"label":"noEarnings","pricePer10":5317071.70287792,"assumptions":"Finite judged diagnostic, not a confidence interval; negative and unknown outcomes are distinct."},{"label":"fullOverlap","pricePer10":5317071.70287792,"assumptions":"Finite judged diagnostic, not a confidence interval; negative and unknown outcomes are distinct."},{"label":"fullIndependence","pricePer10":5077759.4526058715,"assumptions":"Finite judged diagnostic, not a confidence interval; negative and unknown outcomes are distinct."},{"label":"equivalentPurchasedCare","pricePer10":null,"assumptions":"Finite judged diagnostic, not a confidence interval; negative and unknown outcomes are distinct."},{"label":"sameFreeCare","pricePer10":null,"assumptions":"Finite judged diagnostic, not a confidence interval; negative and unknown outcomes are distinct."},{"label":"noClinicalAndNoCash","pricePer10":null,"assumptions":"Finite judged diagnostic, not a confidence interval; negative and unknown outcomes are distinct."},{"label":"noCompletion","pricePer10":null,"assumptions":"Finite judged diagnostic, not a confidence interval; negative and unknown outcomes are distinct."},{"label":"failedBurden","pricePer10":null,"assumptions":"Finite judged diagnostic, not a confidence interval; negative and unknown outcomes are distinct."},{"label":"fastAlternatives","pricePer10":11992788.970064199,"assumptions":"Finite judged diagnostic, not a confidence interval; negative and unknown outcomes are distinct."},{"label":"grossUnknown","pricePer10":5255153.51704092,"assumptions":"Finite judged diagnostic, not a confidence interval; negative and unknown outcomes are distinct."}],"missingInputs":["Current gift-sensitive clinician/host slots, funding backlog and replacement funding.","Deduplicated resident people/households and meaningful completed treatment with joint encounter identities.","Generic utility, persistence, delayed alternatives, dental complications and long-run tooth-loss effects.","Actual net travel/paid-work/Rx/upkeep and household resource/income distributions.","Full net resource and long-run preventive/systemic/portfolio effects; no automatic screening/survival bonus."]},"sources":[{"id":"ram-audit25","title":"FY2025 audited financial statements; auditor report dated July 26, 2026","publisher":"Remote Area Medical / Pugh & Company","url":"https://www.ramusa.org/wp-content/uploads/RAM-Final-2025-Audited-Financial-Statements.pdf","published":null,"retrieved":"2026-10-02","dateNote":"Targeted original PDF pages5-9,12-13,15-17 extracted in-memory, auditor dateJuly26,2026; not full visual reading"},{"id":"ram-audit24","title":"FY2024 audited financial statements, with 2023 comparative","publisher":"Remote Area Medical / Pugh & Company","url":"https://www.ramusa.org/wp-content/uploads/Final-2024-Audited-Financial-Statements.pdf","published":null,"retrieved":"2026-10-02","dateNote":"Original audit extracted web statement/note text covers2024 and2023; auditorJuly27,2025"},{"id":"ram-tax25","title":"FY2025 original Form 990, Part III and Schedule D reconciliation","publisher":"Remote Area Medical / IRS","url":"https://www.ramusa.org/wp-content/uploads/RAM-2025-990-Final-Public.pdf","published":"2026-08-18","retrieved":"2026-10-02","dateNote":"Scanned targeted pages yielded empty text; full tax return not freshly reread. Inherited original990ScheduleD bridge explicitly labeled"},{"id":"ram-output25","title":"RAM by the Numbers: Our Impact in 2025","publisher":"Remote Area Medical","url":"https://www.ramusa.org/02/ram-by-the-numbers-our-impact-in-2025/","published":"2026-02-04","retrieved":"2026-10-02","dateNote":"2025 raw native totals and repeated visits; glasses/teeth/encounters not unique outcomes"},{"id":"ram-faq","title":"Current clinic access and volunteer capacity FAQ","publisher":"Remote Area Medical","url":"https://www.ramusa.org/frequently-asked-questions/","published":null,"retrieved":"2026-10-02","dateNote":"DentalORvision with possible medical, physical firstcome overnight queue and clinician-sensitive slots; not measured failed, income or expense coefficients"},{"id":"ram-host","title":"Community hosting: responsibilities, costs and planning time","publisher":"Remote Area Medical","url":"https://www.ramusa.org/host-a-ram-clinic/","published":null,"retrieved":"2026-10-02","dateNote":"Host clinician recruitment/local expenses, year+new clinic planning; no current funded extra slots"},{"id":"ram-home","title":"Current mobile clinics and Tennessee telehealth","publisher":"Remote Area Medical","url":"https://www.ramusa.org/","published":null,"retrieved":"2026-09-29"},{"id":"ram-unit","title":"Donation illustrations for vision, telehealth and dental care","publisher":"Remote Area Medical","url":"https://telehealth.ramusa.org/grateful-for-your-support-how-you-directly-impact-our-success/","published":null,"retrieved":"2026-09-29"},{"id":"ram-vision26","title":"Free eye exams and eyeglasses: current program description","publisher":"Remote Area Medical","url":"https://www.ramusa.org/05/free-eye-exam-and-eyeglasses-help-ram-patients-see-clearly-again/","published":"2026-05-08","retrieved":"2026-09-29"},{"id":"vision-rct","title":"Randomized immediate versus delayed refractive correction in older US adults","publisher":"Coleman et al., Journal of the American Geriatrics Society","url":"https://pubmed.ncbi.nlm.nih.gov/16776781/","published":null,"retrieved":"2026-09-29"},{"id":"vision-utility","title":"Utility and uncorrected refractive error","publisher":"Tahhan et al., Ophthalmology / Johns Hopkins University","url":"https://pure.johnshopkins.edu/en/publications/utility-and-uncorrected-refractive-error-4/","published":null,"retrieved":"2026-09-29"},{"id":"vision-harm","title":"VISIBLE randomized trial: glasses, falls and adverse effects","publisher":"Haran et al., BMJ","url":"https://www.bmj.com/content/340/bmj.c2265","published":"2010-05-25","retrieved":"2026-09-29"},{"id":"tax24","title":"FY2024 Form 990","publisher":"Remote Area Medical","url":"https://www.ramusa.org/wp-content/uploads/RAM-990-2024.pdf","published":null,"retrieved":"2026-09-29"},{"id":"tax23","title":"FY2023 Form 990","publisher":"Remote Area Medical","url":"https://www.ramusa.org/wp-content/uploads/RAM-990-for-2023.pdf","published":null,"retrieved":"2026-09-29"},{"id":"map-owner","title":"Official impact map embedding the public dataset","publisher":"Remote Area Medical","url":"https://www.ramusa.org/our-impact/","published":null,"retrieved":"2026-09-29"},{"id":"map-data","title":"Official embedded event/service map data","publisher":"Remote Area Medical","url":"https://raw.githubusercontent.com/ITDeptAdmin/ImpactMap/main/output/ImpactMap_Dataset.geojson","published":null,"retrieved":"2026-10-02","dateNote":"Author direct body/schema verification, inherited counts independently confirmed by root fresh same-hash aggregation; root coding/source time not counted here"},{"id":"erie25","title":"2025 Erie host impact report","publisher":"BUILD / Erie clinic host","url":"https://www.builderie.org/assets/RAM-Impact-Report-2025.pdf","published":null,"retrieved":"2026-09-29"},{"id":"telehealth","title":"Current hybrid telehealth scope and constraints","publisher":"Remote Area Medical","url":"https://www.ramusa.org/telehealth/","published":null,"retrieved":"2026-10-02","dateNote":"Acute bridge,30dayrefill maximum, patient-paid Rx, no labs/X-rays or continuing care; completion effect is judgment"},{"id":"dental-cohort","title":"Wigsten et al. 2023 root canal versus extraction cost-utility cohort","publisher":"Wigsten et al., Clinical and Experimental Dental Research","url":"https://onlinelibrary.wiley.com/doi/10.1002/cre2.759","published":null,"retrieved":"2026-10-02","dateNote":"Directbodyblocked; web-rendered original abstract/results/discussion freshly readable"},{"id":"ram-thrive","title":"THRIVE randomized trial: selected Bangladesh presbyopic workers and self-reported income","publisher":"Sehrin et al., PLOS ONE","url":"https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0296115","published":null,"retrieved":"2026-10-02","dateNote":"Targeted primary abstract/methods; no direct percentage transfer to USA wages."},{"id":"ram-prosper","title":"PROSPER trial: occupational tea-output effect, primary abstract only","publisher":"Reddy et al., Lancet Global Health","url":"https://www.sciencedirect.com/science/article/pii/S2214109X18303292","published":null,"retrieved":"2026-10-02","dateNote":"Indexed primary summary, not a fresh full-paper read."},{"id":"ram-income-method","title":"Health and income cost-effectiveness reference","publisher":"Coefficient Giving","url":"https://coefficientgiving.org/research/cost-effectiveness/","published":null,"retrieved":"2026-09-30","dateNote":"Inherited reference framework from September source review; not freshly retrieved in this phase."}]}