Remote Area Medical

Ordinary unrestricted recipient support. All recipient functions, fundraising, rental expenses and depreciation are retained in C; only recorded volunteer labor is removed for a support-dollar throughput anchor. C=10522622 is not marginal cash cost. The full-resource sensitivity restores volunteer labor. Local host costs, volunteer travel, unrecorded supplies and patient waiting/travel are additional societal costs not fully measured. G=10000 is arithmetic normalization only.

USA means residents of 50 states and DC, not clinic citizenship or headquarters. Original return includes 7402 Philippine patients in 32770 total, while blog describes 27 states. 25368/32770=.7741 is a raw patient ratio, not a health-weighted share and not used as observed g. Unknown geographic/service-scope reconciliation; conditional g=.75 with .5 and 1 stress cases. Some reported international output may be affiliate activity outside recipient costs. That must be reconciled before using any total as a production denominator.

D=sum[t=1..T]((1−m)/1.03)^t. q_v=f×s×u×p×D−h. A=N_v×q_v+H_other. Q_all=(G/C)×b×A; Q_USA=Q_all×g; price=10G/Q_USA if positive. N_v is eye exams, not pairs. f is fraction yielding meaningful correction, p effective sustained use, s benefit not obtained otherwise. h is incremental adverse burden versus the actual alternative. It remains at s=0 only when an extra exam or prescription imposes new burden; identical replacement care cancels shared harms. H_other is annual-scale net dental/medical QALYs after deduplication and harms. Central b and g are judgments; H_other=0 leaves other health unpriced, not a proven lower bound.

G

10000 USD normalization (judgment). Arithmetic scale only.

FY2025 gross expense

19852655 USD (observed). Audited total with all functions and donated services; independently visual-checked. [ram-audit25]

Recorded volunteer labor

9330033 USD accounting value (observed). Recognized expense and contribution, not donor cash or health benefit. [ram-audit25] [ram-tax25]

C

10522622 USD per annual historical service scale (judgment). 19852655−9330033; entire recipient remaining expense. Includes 172918 rental expense netted from tax return, depreciation and some noncash supplies. Not a marginal cash-cost estimate. [ram-audit25] [ram-tax25]

N_v

7999 eye exams in2025 (observed). Output scope/location and unique persons unresolved; do not use 15013 pairs as patients. [ram-output25] [ram-tax25]

b

0.5 funding/capacity-sensitive throughput fraction (judgment). We adopt 50% financing-sensitive throughput: cash supports a demonstrated clinic network, but volunteers, hosts and replacement funding constrain expansion. The 75% USA health share is a cautious allocation judgment, not a raw patient share. Full cash-support expenses are charged against vision health; dental and other medical benefits remain unpriced. [ram-faq] [ram-host] [ram-audit25]

f

0.6 meaningful correction per eye exam (judgment). Conditional 60%; .2–.9 stress. Exams can detect nonrefractive disease or produce small prescription changes. Recipient severity and dispensing completion absent. [ram-faq] [vision-rct]

s

0.5 fraction of benefit not otherwise obtained (judgment). Allows later public, charitable or purchased correction. Test 0–.8. Access barriers support need but do not measure substitution. [ram-faq]

u

0.04 QALY per effectively corrected year (judgment). Small transfer judgment relative to cross-sectional uncorrected utility deficits; not a NEI-VFQ mapping or measured RAM treatment effect. Test 0–.08. [vision-rct] [vision-utility]

p

0.8 effective sustained use (judgment). Allows nonuse, breakage, loss and poor adaptation. Test.5–.9; recipient follow-up missing. [vision-rct] [vision-harm]

T

3 years (judgment). Conditional durability,1–4 years; not established by short trial. [vision-rct]

m

0.01 annual competing mortality (judgment). Mixed-age allowance; no survival benefit. Stress.005–.03.

h

0.0002 QALY per additional exam pathway (judgment). Adverse/adaptation burden allowance, not observed event rate. Includes weak-correction pathways. Test.0001–.0005; no broad falls benefit. Incremental relative to actual alternative care; shared burdens cancel under identical replacement. [vision-harm]

g

0.75 USA health share (judgment). We adopt 50% financing-sensitive throughput: cash supports a demonstrated clinic network, but volunteers, hosts and replacement funding constrain expansion. The 75% USA health share is a cautious allocation judgment, not a raw patient share. Full cash-support expenses are charged against vision health; dental and other medical benefits remain unpriced. [ram-tax25] [ram-output25]

H_other

0 net QALYs per annual historical scale (judgment). We adopt 50% financing-sensitive throughput: cash supports a demonstrated clinic network, but volunteers, hosts and replacement funding constrain expansion. The 75% USA health share is a cautious allocation judgment, not a raw patient share. Full cash-support expenses are charged against vision health; dental and other medical benefits remain unpriced. [ram-output25]

Best estimate — explicit judgment: Cost: $10K; USA QALYs: 0.0753153208445622; all-population QALYs: 0.10042042779274961. C=10522622; N=7999; b=0.5; f=0.6; s=0.5; u=0.04; p=0.8; T=3; m=0.01; D=2.772964336014393; h=0.0002; g=0.75. Dental and medical net outcomes unquantified, set zero only for this vision-path test. We adopt 50% financing-sensitive throughput: cash supports a demonstrated clinic network, but volunteers, hosts and replacement funding constrain expansion. The 75% USA health share is a cautious allocation judgment, not a raw patient share. Full cash-support expenses are charged against vision health; dental and other medical benefits remain unpriced.

Vision-only conditional throughput case: Cost: $10K; USA QALYs: 0.0753153208445622; all-population QALYs: 0.10042042779274961. C=10522622; N=7999; b=0.5; f=0.6; s=0.5; u=0.04; p=0.8; T=3; m=0.01; D=2.772964336014393; h=0.0002; g=0.75. Dental and medical net outcomes unquantified, set zero only for this vision-path test.

Durable high-yield vision case: Cost: $10K; USA QALYs: 1.446097156939923; all-population QALYs: 1.446097156939923. C=10522622; N=7999; b=1; f=0.9; s=0.8; u=0.08; p=0.9; T=4; m=0.005; D=3.671546124436823; h=0.0001; g=1. Dental and medical net outcomes unquantified, set zero only for this vision-path test.

Short weak correction with alternatives: Cost: $10K; USA QALYs: -0.00008903186546463245; all-population QALYs: -0.0001780637309292649. C=14000000; N=7999; b=0.1; f=0.2; s=0.2; u=0.01; p=0.5; T=1; m=0.03; D=0.9417475728155339; h=0.0005; g=0.5. Dental and medical net outcomes unquantified, set zero only for this vision-path test.

No additional clinic throughput: Cost: $10K; USA QALYs: 0; all-population QALYs: 0. C=10522622; N=7999; b=0; f=0.6; s=0.5; u=0.04; p=0.8; T=3; m=0.01; D=2.772964336014393; h=0.0002; g=0.75. Dental and medical net outcomes unquantified, set zero only for this vision-path test.

Extra duplicative exam without additional correction benefit: Cost: $10K; USA QALYs: -0.0005701288139020864; all-population QALYs: -0.0007601717518694486. C=10522622; N=7999; b=0.5; f=0.6; s=0; u=0.04; p=0.8; T=3; m=0.01; D=2.772964336014393; h=0.0002; g=0.75. Dental and medical net outcomes unquantified, set zero only for this vision-path test. This is extra, duplicative care with new burden; it is not a mere change of provider for identical care.

Recorded volunteer resource costs included: Cost: $10K; USA QALYs: 0.039919831984993895; all-population QALYs: 0.053226442646658524. C=19852655; N=7999; b=0.5; f=0.6; s=0.5; u=0.04; p=0.8; T=3; m=0.01; D=2.772964336014393; h=0.0002; g=0.75. Dental and medical net outcomes unquantified, set zero only for this vision-path test.

Counterfactual: b discounts donor replacement, reserves, fixed volunteer slots and local-host constraints, separately from s for patient alternatives. Patients may obtain later care through Medicaid, community clinics, other charities, family payments or low-cost optical services. No-insurance status does not prove no substitute. Public funding saved is not counted as a health gain; any downstream use is unmodeled. Donated clinician opportunity cost may include other care forgone. The negative alternative-care test means an extra duplicative exam or prescription with no extra correction benefit. It is not identical replacement care, for which shared burdens cancel.

Attribution: Full recipient expense supports only the vision pathway in the conditional test; dental and medical benefits are not silently attributed to glasses. Two pairs do not create two independent QALY streams. Extractions/fillings can overlap within the same pain episode. Screening and telehealth encounters are not credited without treatment completion. Geography and affiliate-cost scope need reconciliation. A positive conditional number does not overcome unknown marginal throughput.

We adopt 50% financing-sensitive throughput: cash supports a demonstrated clinic network, but volunteers, hosts and replacement funding constrain expansion. The 75% USA health share is a cautious allocation judgment, not a raw patient share. Full cash-support expenses are charged against vision health; dental and other medical benefits remain unpriced. Zero and adverse outcomes remain possible; the quantified pathway is not a complete portfolio valuation.

Sensitivity

• Conditional vision-only price≈$1.33 million/10; favorable≈$69000; unfavorable and fixed-capacity cases have no positive price. These are not confidence limits or a bounded range.
• At conditional clinical inputs and g=.75, b must be≥.6639 for $1 million/10 or≥6.639 for $100000/10. The tighter threshold cannot be achieved on that vision pathway merely by funding more of the same mix.
• At b=.5 and g=.75, annual-scale total net QALYs must be≥280.603 for $1 million/10 or≥2806.033 for $100000/10. Conditional vision supplies 211.337; H_other must add≥69.266 or≥2594.695 respectively. These are required net health gains, not outputs or measured effects.
• Restoring recorded volunteer resource cost raises the conditional price to≈$2.51 million/10, still excluding unrecorded volunteer travel, host expenditure and patient waiting. This is a resource-cost sensitivity, not the cash donation price.
• If all meaningful corrections occur in USA residents, g=1 reduces the conditional vision price to≈$996000/10; if g=.5 it rises to≈$1.99 million. Neither patient counts nor affiliate headquarters establish this health share.
• If treatment merely replaces equivalent later correction, s=0 preserves adverse burden and produces negative net modeled vision health. If cash cannot unlock clinicians/hosts, b=0 gives zero.
• A $100 eye-exam-and-glasses fundraising illustration is not substituted for the full-recipient $1315 historical cost per eye-exam pathway. Restricting spending to a favored program would answer a different donation question.
• Improved visual function does not automatically mean fewer falls, survival, learning gains or earnings; no such addition is credited. Dental pain relief may be important but teeth extracted cannot be assigned independent patient-level QALYs.

Unresolved inputs

• Funding-contingent clinic/telehealth expansion plan, confirmed clinicians and hosts, contribution replacement and current cost per additional completed service mix.
• Reconciliation of 32770 headline patients,7402 Philippine patients,436 clinics and 7999 eye exams, with domestic/foreign resident health and recipient-versus-affiliate cost scope.
• Unique patients with meaningful corrected acuity, severity, prior glasses, dispensing completion and sustained use; generic utility and adverse effects.
• Unique symptomatic dental patients and causal pain/function improvement, duration, repeat procedures, complications and alternative treatment timing.
• Medical screening referrals, diagnoses, treatment initiation and longitudinal outcomes, avoiding overlap with dental/vision cases.
• Current building/capacity utilization, loan repayment funding, local host costs, volunteer travel/opportunity cost and patient waiting/travel burden.