Economic burden of comorbid chronic kidney disease and diabetes

Objective: To estimate real-world healthcare utilization and expenditures across the spectrum of chronic kidney disease (CKD), as determined by estimated glomerular filtration rate (eGFR) categories in patients with diabetes.

Methods: This study employed a retrospective cohort study design using the Truven Healthcare and Claims Dataset from 2009–2012. Index date was defined as the first eGFR value during a continuous enrollment period of 24 months. Cohorts of patients were stratified by Kidney Disease: Improving Global Outcomes CKD stage based on eGFR (stages 1: ≥90?mL/min/1.73?m²; 2: 60–89; 3A: 45–59; 3B: 30–44; 4: 15–29; 5: <15). Healthcare expenditures (total patient and payer paid claims) and utilization (number of claims or visits) were estimated 12-months post-index date using generalized linear modeling and negative binomial modeling, respectively, after adjusting for baseline characteristics.

Results: Of 130,098 patients with an index eGFR value and 24-months continuous enrolment, 64,521 (49.59%) were in stage 1 CKD, 47,816 (36.75%) were in stage 2, 13,377 (10.28%) were in stage 3A, 3,217 (2.47%) were in stage 3B, 898 (0.69%) were in stage 4, and 269 (0.21%) were in stage 5. Patients in stages 3A, 3B, and 4 CKD had 1.32 (95% CI?=?1.22–1.43), 1.59 (95% CI?=?1.41–1.80), and 2.65 (95% CI?=?2.23–3.14) times higher rates of diabetes-associated inpatient visits, respectively, compared with stage 1 CKD patients. Patients in stages 3A, 3B, and 4 CKD had increased incremental total annual healthcare expenditures of $1,732 (95% CI?=?$1,109–$2,356), $2,632 (95% CI?=?$1,647–$3,619), and $6,949 (95% CI?=?$5,466–$8,432), respectively, compared with stage 1 CKD patients.

Limitations: The claims data were generated for billing and reimbursement, not for research purposes.

Conclusions: These real-world data suggest an incremental and significant increase in economic burden in diabetes as kidney function declines, starting with moderate (stage 3A) CKD.     

Extraneous Alternatives And Strategy-Proofness

It is well known that the Gibbard–Satterthwaite theorem cannot be circumvented by adding extraneous alternatives that are included in the individual preference information but are never selected. We generalize this by proving that, for any domain on which every strategy-proof rule is dictatorial, the addition of extraneous alternatives will not permit the construction of a non-dictatorial and strategy-proof rule if the new domain is a product set. We show how this result, and our other theorem, can be applied to seven families of social choice situations, including those in which more than one alternative is selected.     

Board Composition And Corporate Use Of Interest Rate Derivatives

We provide new evidence on the motives for corporate hedging by examining the relation between the quality of the firms' monitoring mechanisms and the quantity of interest rate derivatives employed. Because the capital structure decision and hedging decision are considered to be endogenous, the firm's capital structure and level of interest rate derivative use are modeled simultaneously. We show a positive relation between the relative influence of outside directors and the quantity of derivatives used. This evidence indicates that outside directors take an active role in derivatives usage and that firms employ hedging in the shareholders' best interests.     

The Unimportance of Labels: The Diffusion of the Personnel/HRM Function

The important debate on the relationship between personnel specialists and line managers is the theme of this article. It argues, on empirical evidence, that the development of the relationship has not been to the detriment of personnel managers but has secured mutual benefits for both themselves and their line counterparts.     

Relaxing Pareto optimality in economic environments

Summary.  The individual preference domain is the family of profiles of economic preferences on the set of allocations of public or private goods, or both. The agenda domain assumption allows for a finite lower bound on the size of a feasible set. If a social choice correspondence satisfies nonimposition, Arrow’s choice axiom, and independence of infeasible alternatives then it is directly or inversely dictatorial, or null. Received: October 10, 1995; revised version: June 20, 1996     

Will employee choice and defined contribution health plans salvage the embattled managed care system?

Defined contribution or consumer-driven health approaches will shift to employees not just the risks and rewards of the managed care system, but also decisions that will determine whether that system can survive. This article reviews the current state of the employer-sponsored health care system, describes defined contribution and consumer-driven health plan concepts, and outlines the approaches and steps employers can take to implement them. The author argues that, if fully implemented, such approaches could salvage the embattled managed care system by giving employees a financial stake in controlling medical costs while educating them to wisely take control of health plan spending decisions.     

Employment rights: A Lockean perspective

This article presents a framework for the consideration of employment as a property right using the relationships of basic rights as outlined by John Locke. The framework is applied to modern American corporations, and typical voluntary job protection mechanisms are reviewed.