The Load Model: an alternative to QALY

Background: QALYs are widely used in health economic evaluation, but remain controversial, largely because they do not reflect how many people behave in practice. This paper presents a new conceptual model (Load Model) and illustrates it in comparison with the QALY model.

Methods: Load is the average annual weight attributed to morbidity and mortality over a defined period, using weightings based on preference judgements. Morbidity Load is attributed to states of illness, according to their perceived severity. When people are in full health, Load is zero (no morbidity). Death is treated as an event with negative consequences, incurred in the year following death. Deaths may be weighted equally, with a fixed negative weight such as ?100, or differ according to the context of death. After death, Load is zero. In a worked example, we use the standard gamble method to obtain a weighting for an illness state, for both Load and QALY models. A judge is indifferent between certainty of 1.5 years’ illness followed by death, or a 50/50 chance of 1.5 years’ full health or 1-year illness, each followed by death. The weightings calculated are applied to a hypothetical life, 72 years in full health followed by 3 years with illness then death, using both models. Three other hypothetical outcomes are also compared.

Results: For an example life, the relative size of the morbidity component compared with the mortality component is much higher in the Load model than in the QALY model. When comparing alternative outcomes, there are also substantial differences between the two models.

Conclusions: In the Load model the weight of morbidity, relative to mortality, is very different from that in the QALY model. Given the role of the QALYs in economic evaluation, the implications of an alternative, which generates very different results, warrant further exploration.     

Environmental Regulation and Innovation Offsets in the Bluegrass Seed Industry

Burning bluegrass seed stubble is an important production practice that, among other benefits, increases production and stand life of this perennial crop. Despite economic forecasts that higher production costs from the 1996 state ban on seed stubble burning would reduce Washington production by up to 30%, output in the years 1998–2005 was nearly two-thirds higher than in any previous eight-year period. This study seeks to explain why that paradoxical behavior occurred. This study puts forward and systematically tests several hypotheses. The only hypothesis with any support, innovation offsets, is examined by an assessment of contemporaneous innovations and by corroborative statistical evidence.     

The Relation between Stakeholder Management,Firm Value,and CEO Compensation: A Test of Enlightened Value Maximization

Whether firms pursue shareholder value maximization or the maximization of stakeholder welfare is a controversial issue whose outcomes seem irreconcilable. We propose that firms are likely to compensate their executives for pursuing the firm's goal be it shareholder value maximization or the maximization of stakeholder welfare. In this paper, we examine the correlation between firm value, stakeholder management, and compensation. We find that stakeholder management is positively related to firm value. However, firms do not compensate managers for having good relationships with its stakeholders. These results do not support stakeholder theory. We also find an endogenous association between compensation and firm value. Our results are consistent with Jensen's (2001) enlightened value maximization theory. Managers are compensated for achieving the firm's ultimate goal, value maximization. However, managers optimize interaction with stakeholders to accomplish this objective.     

Economic Growth and Political Regimes

The absence of continuous regime type measures that focus on institutions rather than outcomes besets studies on whether democratic or authoritarian regimes grow faster. Additional shortcomings include the failure to consider development stages and the erroneous endogenous specification of regimes. Given panel data on 105 countries from 1960 to 1989, the effective party/constitutional framework measure does not correlate with growth or investment in the total sample. But considering development levels, some evidence indicates that discretion decreases growth in advanced areas, and, contrary to theory, inhibits investment in poorer countries. Also, single-party dictatorships have higher investment ratios but do not grow faster than party-less regimes.     

Employee voice: does union membership matter?

Industrial relations research has traditionally viewed trade unions as the primary mechanism for employee voice. With the decline in unionism in many advanced industrial economies over the past two decades, new direct non-union voice mechanisms have been introduced by employers. This focus on the mechanisms for employee voice, however, fails to take account of employees' perceptions of voice. We suggested that employee perceptions of voice vary between the different levels of an organisation and proposed that trade union membership will be more likely to enhance individual employee perceptions of voice at the wider organisational level. Contrary to our expectations, our analysis of 2,949 employees of a public sector scientific research organisation found that union membership had a significant negative impact on employee voice at the organisational level. The article concluded by offering possible explanations for this unexpected finding and the implications for theory, management and future research.     

Beer Taxation and Alcohol-Related Traffic Fatalities

Most studies of alcohol-related traffic fatalities find beer taxes to be an important policy variable. This is surprising since beer taxes only have a small impact on consumption and heavy drinkers are the least responsive to prices. This study shows that the tax relationship is not robust across data periods and that it reflects missing variable biases. While lack of control for law enforcement effort does not appear to bias tax coefficients, failure to include determinants of alcohol consumption other than taxes and drinking age and/or factors that simultaneously determine drinking behavior and political support for alcohol taxes apparently do.     

Sundstrand: A Case Study in Transformation of Cultural Ethics

This analysis examines whistleblowing within the context of organizational culture. Several factors which have provided impetus for organizations to emphasize ethical conduct and to encourage internal, rather than external, whistleblowing are identified. Inadequate protection for whistleblowers and statutory enticement for them to report ethical violations externally are discussed. Sundstrand's successful model for cultural change and encouragement of internal whistleblowing is analyzed to show how their model of demonstrating management's commitment to ethical conduct, establishing ethical expectations of employees, training to ensure that employees understand the concepts and expectations, promoting of employee ownership of the program, making the program visible, protecting the whistleblower and undertaking periodic reviews of the program's success may serve as a model for other organizations.