论盈余管理的动机及其影响

盈余管理是会计政策的选择具有经济后果的一种具体表现,只要上市公司的管理人员有选择不同会计政策的自由,他们必定会选择使其效用最大化或上市公司的市场价值最大化（股价最大化）的会计政策。企业或相关人员可能出于筹资、节税、逃避处罚、获得报酬、减压、蒙蔽社会公众和政府等多种动机进行盈余管理,其影响表现为消极和积极两个方面。     

The impact of stress management on nurse productivity and retention

Throughout the history of nursing there is a seeming legacy of personnel shortage, lack of funds, and, based on the nature of the role and related services, heightened levels of stress involved in patient care. The future of the profession, and more imminently, patient care and the health of nurses, may be significantly impacted by repeated challenges where current levels of stress and burnout are contributing to organizational problems, burnout, and attrition. Employee stress and burnout commonly lead to myriad health-related problems that result in significant organizational consequences. There are many methods of stress management, and sometimes the best and most effective begin with simple recognition, validation, and visible and committed efforts by the nurse executive. Regardless of the technique or approach, what is clear is that there is a need for nurse executives to include the development and enhancement of comprehensive stress-management programming for employees as a priority item to avoid burnout and attrition.     

Understanding the economic burden of heart failure in China: impact on disease management and resource utilization

Introduction and objectives: This study has two objectives: (1) to examine healthcare resource utilization in heart failure (HF) patients; and (2) to examine the treatment costs associated with HF in China.

Methods: The data used in this study was from the 2014 national insurance database sponsored by the China Health Insurance Research Association (CHIRA), that covers national urban employees and residents. ICD-10 codes and keywords indicating heart failure diagnoses were used to identify patients with heart failure. Drug utilization, hospital visits, re-admission, and treatment costs in different service categories were examined.

Results: A total of 7,847 patients were included in this analysis, of which 1,157 patients had a 1-year complete follow-up period. In total, 48.16% of patients received the combination treatment of angiotensin-converting-enzyme inhibitor (ACEI)/angiotensin II receptor blockers (ARB) and beta-blockers (BB); and 22.87% of patients received the combination treatment of ACEI/ARB, beta-blockers and Mineralocorticoid receptor antagonists (MRAs). The annual treatment cost per patient with HF diagnosis was RMB 28,974, of which 66% was for inpatient care. The cost on HF medications accounted for 8.2% of annual cost. Treatment cost was much higher in provincial-level municipalities than that of prefecture-level and other cities.

Discussion and conclusion: Hospitalization is a major driver of HF treatment cost. Compared to the requirements in international treatment guidelines, HF standard of care medication treatment was under-utilized among HF patients in China. The high re-admission rate among Chinese patients indicates that the management of HF needs to be improved. The percentage of GDP spent on treating HF patients was much lower than that in the developed countries.     

Machine performance centres: a survey of technology management issues and their impact on industrial corporate competitiveness

This paper reports the results of a machina performance centre survey of 54 industrial manufacturers in the USA. Here a machine performance centre refers to the technological or mechanical components of a production floor, i.e. machinery, used intentionally to produce a pre-established form of output. The paper details findings and analyzes survey results both individually and comparatively with traditional Japanese manufaturing plactices in order to prova that the demise of many US industrial manufacturerc has been caused in large part by internal technology management failures. The results provide the basis for the proposed conceptual framework for machine performance centre management described within the context of the paper. Substantive effort is made to describe the potential implications of the research on corporate competitiveness and machine performance centre management while the empirical message is azmed at providing a new premise of thinking for the management of industrial manufacturing organizatzons.     

Laparoscopic adjustable gastric banding vs standard medical management in obese patients with type 2 diabetes: a budget impact analysis in the UK

Abstract

Objective:

To evaluate the financial consequences of using laparoscopic adjustable gastric banding (LAGB) in place of standard medical management (SMM) in obese patients with type 2 diabetes from a UK healthcare payer perspective.     

Complex home care: part III--economic impact on family caregiver quality of life and patients' clinical outcomes

Family caregivers perform a significant role in the care of patients with chronic illnesses and prescribed life-long complex home care treatments. Both quantitative and qualitative data from this study suggest the mental health burdens and financial costs of home parenteral nutrition (HPN) caregiving are extensive. In this study, the variability in HPN out-of-pocket expenses and the uncertainty of incurring such extensive costs created additional financial worries within already stressed families. Based on these data, interventions to improve caregivers' sleepiness, depression, and physical health could be hypothesized to improve both patients' and caregivers' quality of life and reduce the frequency of patients' catheter-related infections. These specific nursing interventions also could improve caregiver health and subsequently reduce the costs of caregivers' health care.     

New human resource management practices, complementarities and the impact on innovation performance

In this paper, we take our theoretical point of departure inrecent work in organisational economics on systems of humanresource management (HRM) practices. We develop the argumentthat just as complementarities between new HRM practices influencefinancial performance positively, there are theoretical reasonsfor expecting them also to influence innovation performancepositively. We examine this overall hypothesis by estimatingan empirical model of innovation performance, using data froma Danish survey of 1,900 business firms. Using principal componentanalysis, we identify two HRM systems which are conducive toinnovation. In the first one, seven of our nine HRM variablesmatter (almost) equally for the ability to innovate. The secondsystem is dominated by firm-internal and firm-external training.Of the total of nine sectors that we consider, we find thatthe four manufacturing sectors correlate with the first system.Firms belonging to wholesale trade and to the ICT intensiveservice sectors tend to be associated with the second system.     

网上录取对考试档案管理的影响与应对

随着我国科学信息技术的发展,网上录取招生逐渐成为主流的趋势,而考试档案管理是学生录取过程中的必经流程。同时网上录取会在一定程度上影响考试档案的管理方式。本文先对网上录取模式进行了介绍,对网上录取方式对考试档案管理工作所产生的影响进行了探讨与分析,旨在为网上录取工作的开展提供一定的帮助。     

劳资关系对当代中国社会的影响

改革开放以来对社会触动最大的变革莫过于企业劳动关系的变动.劳资关系从无到有并成为劳动关系的主体对中国社会的影响有积极和消极两个方面.积极影响主要表现在牵引和带动了公有制企业市场化改革、缓解了中国工业化进程中的人口难题和广泛吸纳投资推进了中国工业化进程;消极方面主要表现为带来了利益大分化的劳动关系、天生不平等的社会关系、倾斜性的初次分配关系.从总的来看,其积极影响大于消极影响.但是,目前积极影响下降而消极影响上升,因此,构建劳资关系的制衡机制是一项十分紧要的工作.     

金融危机对巴塞尔新资本协议和商业银行风险管理的挑战

正在影响着世界的金融危机,在考验商业银行自身的风险管理能力的同时,也挑战了全球银行业赖以为标准的巴塞尔新资本协议。本文旨在从危机爆发的原因出发,封新资本协议关于银行的风险管理方面的规定进行分析,以及在金融全球化的大环境下,中国的银行业应该如何应对危机。     

Long-term disease history,clinical symptoms,health status,and healthcare utilization in patients suffering from Lambert Eaton myasthenic syndrome: Results of a patient interview survey in Germany

Abstract

Introduction:

The burden of disease in Lambert-Eaton myasthenic syndrome (LEMS) patients is unclear. This study focused on the patient’s perspective to obtain patient-reported information on clinical symptoms, burden of illness, impact of LEMS on activities of daily living (ADL), and management of LEMS.

Methods:

Semi-structured, face-to-face interviews with LEMS patients from two specialized centres in Germany between September and December 2010.

Results:

Twelve patients participated; mean age 66.7?±?9.8 years. First symptoms occurred at age 52.5?±?14.0 years. Mean time between first symptoms and diagnosis was 4.4?±?6.2 years. Patients reported neuromuscular, cranial, and autonomic symptoms plus general fatigue. Two-thirds of patients reported 10 or more symptoms. The most frequent symptoms were leg weakness (91.7%) and general fatigue (83.3%). Restrictions in ADL were reported always or often in 75% of patients. Over half of the patients (n?=?7) reported poor or very poor health status. Mean EQ-5D utility scores were 0.34?±?0.35, with little day-to-day variation. Patients visited a number of different clinicians; most had been hospitalized at some point in the course of their disease. The most frequent drug treatments were 3,4-diaminopyridine (3,4-DAP) (83.3%) and pyridostigmine (41.5%). The study has several limitations, including small sample size and the potential influence of recall bias.

Conclusion:

LEMS patients report long individual disease histories. Most patients suffer multiple symptoms which are frequently severe and troublesome, and almost all are restricted in ADL with poor health status. There is high utilization of healthcare resources from diagnosis to ongoing treatment. Physicians should be aware of this rare disease to ensure that patients receive an early diagnosis and prompt and appropriate treatment.     

Historical clinical and economic consequences of anemia management in patients with end-stage renal disease on dialysis using erythropoietin stimulating agents versus routine blood transfusions: a retrospective cost-effectiveness analysis

Abstract

Objective:

To determine whether Medicare’s decision to cover routine administration of erythropoietin stimulating agents (ESAs) to treat anemia of end-stage renal disease (ESRD) has been a cost-effective policy relative to standard of care at the time.

Methods:

The authors used summary statistics from the actual cohort of ESRD patients receiving ESAs between 1995 and 2004 to create a simulated patient cohort, which was compared with a comparable simulated cohort assumed to rely solely on blood transfusions. Outcomes modeled from the Medicare perspective included estimated treatment costs, life-years gained, and quality-adjusted life-years (QALYs). Incremental cost-effectiveness ratio (ICER) was calculated relative to the hypothetical reference case of no ESA use in the transfusion cohort. Sensitivity of the results to model assumptions was tested using one-way and probabilistic sensitivity analyses.

Results:

Estimated total costs incurred by the ESRD population were $155.47B for the cohort receiving ESAs and $155.22B for the cohort receiving routine blood transfusions. Estimated QALYs were 2.56M and 2.29M, respectively, for the two groups. The ICER of ESAs compared to routine blood transfusions was estimated as $873 per QALY gained. The model was sensitive to a number of parameters according to one-way and probabilistic sensitivity analyses.

Limitations:

This model was counter-factual as the actual comparison group, whose anemia was managed via transfusion and iron supplements, rapidly disappeared following introduction of ESAs. In addition, a large number of model parameters were obtained from observational studies due to the lack of randomized trial evidence in the literature.

Conclusions:

This study indicates that Medicare’s coverage of ESAs appears to have been cost effective based on commonly accepted levels of willingness-to-pay. The ESRD population achieved substantial clinical benefit at a reasonable cost to society.     

Medical economic impact of tracheotomy patients on a hospital system

Abstract

Background:

Tracheotomy patients are a small portion of hospitalizations, but account for disproportionately high risk and costs. There are many complex decisions that go into the care of these patients, and practice variation is expected to be compounded in a health system. This study sought to characterize the medical economic impact of tracheotomy patients on the hospital system.

Methods:

A retrospective review of the health system’s hospital billing software was performed for 2013, and pertinent outcomes measures were tabulated.

Results:

There were 829 tracheotomies performed in the health system of seven hospitals, with total costs of $128,883,865. Average length of stay was 36.74 days for principal procedures, and 43.36 days for tracheotomy as secondary procedures. Mortality was ～18% overall, and re-admissions were 10.93% for primary, and 14.36% for secondary procedures. A fairly wide variation in each category among the different hospitals was observed.

Conclusions:

There are potentially many factors that impact variations of care and outcomes in patients with tracheotomy. Due to their large economic impact and risks for morbidity and mortality, a formalized care pathway is warranted. Goals of the pathway should include understanding medical decisions surrounding these complex patients, monitoring pertinent outcomes, reducing practice variation, and improving the efficiency of compassionate care.     

Hospital patients with severe wounds: early evidence on the impact of Medicare payment changes on treatment patterns and outcomes

Aims: This study examines the effects of recent changes in Medicare long-term care hospital (LTCH) payments on treatment patterns and outcomes for severe wound patients discharged from short-term acute care hospitals (STACHs).

Materials and methods: The rolling implementation of a new Medicare payment policy was used to develop a difference-in-difference model. The study population consisted of Medicare beneficiaries subjected to the payment policy changes and hospitalized for stage 3, 4, or unstageable wounds; non-healing surgical wounds; and fistula. Using 2015-Q1-2017 Medicare claims data, changes in outcomes were examined for severe wound patients exposed to the new policy (treatment) and those that were not (comparison). All outcomes were modeled using linear regressions and adjusted for patient clinical characteristics. Analysis was conducted in a full sample and a sample with high-LTCH-use propensity.

Results: Severe wound patients exposed to the new policy experienced 4.1 and 7.5 percentage point (pp) reductions in LTCH use relative to the comparison group in the full sample and high-LTCH-propensity sample, respectively (p?p?=?.039). No statistically significant change was found in 60-day mortality or Medicare spending after the policy change in the treatment group as compared to the comparison group (p?>?.10). However, among severe wound patients who are exposed to the new policy in the high-LTCH-propensity sample, readmission and post-discharge sepsis rates increased after the policy change relative to the comparison group (readmission rate = 8.1 pp, p?=?.075; sepsis rate = 7.0 pp, p?=?.033).

Limitations: The findings are based on data from a limited timeframe around the policy change and, thus, provide only early evidence on the effects of the new policy.

Conclusion: The new LTCH payment policy is associated with no changes in Medicare spending and mortality, but higher readmissions and post-discharge sepsis rates among severe wound patients with a high likelihood to use an LTCH.     

Using patient-reported outcome assessments in clinical practice and their importance in risk management

Abstract

Patient-reported outcome (PRO) instruments are related to risk management programmes in that they are tools to measure the benefits and risks of exposure to pharmaceutical products from the patient's perspective. Clinical measures of improvement of certain conditions may not necessarily correlate with improvements in a patient's ability to perform daily activities. PRO data, when properly administered, collected, analysed and returned to physicians are a very useful source of information. This will ultimately address safety concerns, facilitate the physician–patient relationship and improve patients' compliance to treatment in routine patient care. In this article we stress the importance of PRO in risk management.     

Collective Choice in the Commons: Experimental Results on Proposed Allocation Rules and Votes

We analyse and empirically examine a multi-level common-pool resource (CPR) game consisting of a collective-choice level game and an operational-level game. In the collective-choice game, participants anonymously propose allocation rules to be used in the operational game and vote anonymously on the proposed rules. Majority and unanimity rules are investigated. Our major finding is that both types of voting rules substantially increase efficiency relative to a baseline with no opportunity for collective choice, but the distributional consequences of the rules differ. To understand the process by which efficiency is improved better, we examine four predictive theories related to proposals, votes, and outcomes.     

Electronic transactions: Their impact on financial reporting

The creation of accounting transactions has changed from a manual to computerized recording. In many operational applications, the accounting entries are generated as a by-product of the underlying transactions, thus making it possible to shorten the existing delays in the creation of accounting data. Under this method, it is possible to issue financial statements monthly or weekly, as opposed to presently used quarterly and annual periods. Many corporations already generate such financial reports for their internal use but not for external purposes. It would be advisable to distribute financial reports via an electronic clearing house. This method would permit instant access to reports and insure that these documents cannot be modified by the preparer.     

London bus tendering: the impact on costs

Bids for cost contracts in London Regional Transport bus routes between 1986 and 1993 are analysed for three purposes: to estimate costs for different types of bus operation; to test hypotheses about bidding under competition; to estimate cost savings attributable to tendering. There is no statistically significant difference in costs of operation between public and private sector operators on the tendered network. Bidding behaviour conforms to some features predicted by theoretical models. The estimated cost saving from tendering is 20%.