Community discussions: a vision for cutting the costs of end-of-life care

Palliative care involvement with patients with advanced disease has demonstrated significant cost savings at end of life (EOL). These financial benefits are largely due to improved EOL decision making. Assisting patients and families to examine their values and determine their preferences makes it possible to match patient goals with appropriate care. Often, comfort-oriented care is favored, avoiding the costs of medically aggressive, often futile, technology-driven interventions. Community-based EOL care discussions would demonstrate increased cost reductions while facilitating significant patient and family satisfaction with care.     

International status seeking, trade, and growth leadership

Abstract .  We study a two-country endogenous growth model where the utility of agents in developing countries is affected by consumption gaps with advanced economies. International status seeking tends to revert growth differentials in favour of the developing country. Preferences with endogenous status desire generate convergence in growth rates in the presence of structural gaps and convergence in income levels if productivity differences disappear. This process is driven by declining terms of trade and faster capital accumulation of the status seeker. The model predictions are shown to be consistent with the stylized facts that characterized the growth performance of East Asian economies.     

James Buchanan's contributions to social and economic thought: Citation counts,self-assessment,and peer review

This paper demonstrates James Buchanan's impact on socio-economic thought through citation analysis of his published works, a discussion of Buchanan's own views of what his work means and is, and summary discussions of the assessments of other scholars. Thus the central themes of his work are illuminated as well. These themes include a deep distrust of government interference in the economy and in the personal lives of members of the polity, and his absolute conviction that collective decisionmaking should take place only within the framework of a contractual agreement, the fundamental principles of which have been derived through near unanimity.     

An OLG model of growth with longevity: when grandparents take care of grandchildren

By assuming that grandparents take care of grandchildren, this paper aims at studying the effects of longevity on long-term economic growth in a model with overlapping generations and endogenous fertility. We show that an increase in longevity may: (i) reduce the long-term economic growth; (ii) increase the supply of labour, and (iii) cause fertility either to increase of decrease depending on the size of time spent by grandparents to rise grandchildren. These findings also hold in an endogenous growth setting à la Romer (J Polit Econ 94:1002–1037, 1986).     

Separating complements: the effects of competition and quality leadership

The literature on the tragedy of the anticommons typically suggests that producers of complementary goods should integrate themselves. Recent decisions by the antitrust authorities seem however to indicate that there exists a tradeoff between the “tragedy” and the lack of competition characterizing an integrated market structure. In this paper we analyze such tradeoff in oligopolistic complementary markets when products are vertically differentiated. We show that quality leadership plays a crucial role. When there is a quality leader, forcing divestitures or prohibiting mergers, thus increasing competition, lowers prices and enhances consumer surplus. However, when quality leadership is shared, “disintegrating” firms may lead to higher prices. In this case, concerns about the tragedy of the anticommons are well posed in antitrust decisions.     

When nursing takes ownership of financial outcomes: achieving exceptional financial performance through leadership, strategy, and execution

With nurses and unlicensed supportive personnel composing the greatest percentage of the workforce at any hospital, it is not surprising nursing leadership plays an increasing role in the attainment of financial goals. The nursing leadership team at one academic medical center reduced costs by more than $10 million over 4 years while outperforming national benchmarks on nurse-sensitive quality indicators. The most critical success factor in attaining exceptional financial performance is a personal and collective accountability to achieving outcomes. Whether it is financial improvement, advancing patient safety, or ensuring a highly engaged workforce, success will not be attained without thoughtful, focused leadership. The accountability model ensures there is a culture built around financial performance where nurses and leaders think and act, on a daily basis, in a manner necessary to understand opportunities, find answers, and overcome obstacles. While structures, processes, and tools may serve as the means to achieve a target, it is leadership's responsibility to set the right goal and motivate others.     

Managed care, quality of care, and patient rights

The growth of managed care has been accompanied by calls for increased government regulation because HMOs and other forms of managed care are seen by the public as more concerned about controlling costs than with protecting the rights of patients to quality care. This paper applies a theory of health care rights and clinical evidence of managed care quality in an analysis of public opinion about managed care. The paper concludes that there is no persuasive evidence that managed care has resulted in a general deterioration in the quality of care and that, with one exception, restrictions imposed by managed care plans are consistent with a theory of health care rights. The paper concludes with the recommendation that public policy should dispense with attempts to fine tune managed care and address an unquestionable violation of health care rights, the failure to guarantee a minimum standard of care to some 43 million Americans.     

Human capital and leadership: the impact of cognitive and noncognitive abilities

We conduct an economic analysis about the impact of human capital on an individual’s potential of becoming a leader based on data from the Programme for the International Assessment of Adult Competencies Survey (PIAAC). Our human capital indicators include not only traditional measures such as education and experience, but also various measures of cognitive and noncognitive ability. Our cognitive ability measures include numeracy, literacy, and problem solving abilities, and noncognitive ability measures include perseverance, motivation to learn, and social trust. We specifically investigate the effect of measurement error and reverse causality on the estimation results. We find that problem-solving ability is the most important in affecting leadership among cognitive ability measures, and perseverance shows the strongest impact among noncognitive ability measures. As a leader supervises more employees, the role of cognitive and noncognitive ability becomes more critical.     

Nursing leadership: championing quality and patient safety in the boardroom

OBJECTIVE: Identify the extent to which hospital boards of trustees, CEOs, and CNOs are engaged in quality and safety at the leadership and governance level and how CNOs can support board engagement in quality and safety. BACKGROUND: Although research is emerging, still relatively little is known about the impact and interface of hospital boards of trustees, CEOs, and nursing executives related to improving quality and patient safety. METHODS: 73 telephone interviews were conducted with hospital board chairs, CEOs, and CNOs from a convenience sample of 63 U.S. hospitals. The interviews (22 of which were with CNOs) lasted 30 to 45 minutes and were supplemented by a focus group of five nursing executives. RESULTS: There are significant differences in the perceptions of CNOs versus those of board chairs and CEOs. CNOs reported a greater familiarity of landmark reports on quality and patient safety than board chairs. CEOs and board chairs gave substantially higher ratings to integration of quality planning. Boards have limited comprehension of salient nursing quality issues. CONCLUSION: CNOs have a critical role as boardroom champions of patient safety and quality improvement.     

Bargaining over productivity and wages when technical change is induced: implications for growth, distribution, and employment

I study a model of growth and income distribution in which workers and firms bargain à la Nash (Econometrica 18(2):155–162, 1950) over wages and productivity gains, taking into account the trade-offs faced by firms in choosing factor-augmenting technologies. The aggregate environment resulting from self-interested, objective function-maximizing decision rules on wages, productivity gains, savings and investment, is described by a two-dimensional dynamical system in the employment rate and output/capital ratio. The economy converges cyclically to a long-run equilibrium involving a Harrod-neutral profile of technical change, a constant rate of employment of labor, and constant input shares. The type of oscillations predicted by the model is qualitatively consistent with the available data on the United States (1963–2003), replicates the dynamics found in earlier models of growth cycles such as Goodwin (A growth cycle, in C.H. Feinstein (ed). Socialism, Capitalism and Economic Growth. Cambridge University Press, Cambridge 1967. Cambridge University Press, Cambridge, 1967); Shah and Desai (Econ J 91:1006–1010, 1981); van der Ploeg (J Macroecon 9:1–12, 1987); Flaschel (J Econ: Zeitschrift für Nationalökonomie 44:63–69, 1984) and Sportelli (J Econ: Zeitschrift für Nationalökonomie 61(1):35–64, 1995), and can be verified numerically in simulations. Institutional change, as captured by variations in workers’ bargaining power, has a positive effect on the long-run rate of growth of output per worker but a negative effect on long-run employment. Economic policy can also affect the growth and distribution pattern through changes in the unemployment compensation, which also have a positive long-run impact on labor productivity growth but a negative long-run impact on employment. In both cases, employment can overshoot its new equilibrium value along the transitional dynamics.     

Boundary spanning leadership,resource mobilisation,and performance of university-industry R&D projects: a study in a Japanese university

Acquisition of university knowledge has grown significantly for firms to complement an internal knowledge base of technological innovation. Recognising the significance, an increasing body of literature has analysed the performance of university-industry R&D projects by adopting managerial and social approaches. Despite the important role played by project leaders, existing research paid scant attention to the critical ability and quality of successful project leaders in acquiring university knowledge. To address these limitations, this study performed a survey of firms that collaborated with the Ritsumeikan University in Japan and investigates the influence of boundary spanning leadership of project leaders in firms on both knowledge and commercial performance of R&D projects. Furthermore, it also evaluates the mediation effect of university resource mobilisation that links boundary spanning leadership and project performance.     

Dividends, safety and liquidation when liabilities are long-term and stochastic

This paper investigates the optimal management of a firm faced with a long-term liability that occurs at a random date. Three issues are analysed: The optimal dividend policy; optimal expenditure on safety to delay the occurrence of the liability; and the optimal liquidation date of the firm. An owner faced with dynamic unlimited liability never liquidates and therefore accumulates capital to the golden rule level. For long-term liabilities, dividend payments and safety expenditure are non-decreasing over time. The owner protected by limited liability may liquidate the firm in finite time in order to avoid paying the liability. If this is the case, then it accumulates less capital than the dynamic unlimited liability owner; and may decrease dividend payments and safety expenditure over time. The paper shows that a finite liquidation date is more likely to be optimal when the arrival rate of the liability occurrence increases over time.