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 changing US–China investment relationship

The United States and China are at a turning point in their investment relationship. China’s previous investments in the United States were predominantly in government securities, while other holdings were negligible. Recently, the accumulation of treasury securities has slowed and direct investments by Chinese firms have risen steeply, with Beijing signaling greater support for portfolio investment outflows as well. This article describes the nascent shift in patterns of Chinese investment in the United States and uses the case of direct investment to examine the implications for US–China relations. We discuss current and future policy issues presented by Chinese foreign direct investment (FDI) in the United States, including national security, market access, and antitrust.     

Signaling Quality and Credibility in Yellow Pages Advertising: The Influence of Color and Graphics on Choice

Abstract

This research investigates the ability of color and graphics to convey information about quality and credibility and their influence on choice in Yellow Pages advertising. In Experiment 1, participants exposed to Yellow Pages ads across three product categories had more favorable attitudes toward the advertisement, advertiser, and quality for ads in color than for noncolored ads. Attitudes about the advertisement, advertiser, quality, and credibility were more favorable for ads with photos than for ads with line art. In both cases, results varied by product category. Experiment 2 tested the effect of color and graphics on selection of a Yellow Pages advertiser across eight product categories. Selection from a 32-page, simulated Yellow Pages booklet was made by 384 subjects. A significant effect for process (full) color and photographic-quality graphics on choice of an advertiser from Yellow Pages was found and varied across product categories. The results also highlight the impact of other variables that are controlled by the advertiser.     

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.