Pricing dynamics and product quality: the case of antidepressant drugs

The rising prices of pharmaceuticals have generated considerable, and often acrimonious, debate. Yet, there is little conceptual work or empirical evidence on pharmaceutical pricing strategies or on the time paths of these prices. This study provides a conceptual framework describing the interplay between quality and product differentiation in determining the preferred pricing strategy. We hypothesize that higher quality products will engage in price skimming strategies in markets where products are sufficiently differentiated, but will choose a market penetration strategy in markets that are less differentiated. We apply an empirical analysis to brand name antidepressants during the years 1999–2002, a market where differences in quality are modest. A nationally representative data set on drug utilization and expenditures is combined with a physician survey on the quality attributes of drugs to examine the effect of drug quality on pharmaceutical pricing strategies. Results indicate that higher quality antidepressants engage in a market penetration strategy, charging initially lower prices that rise over time. At approximately 6–7 years post-entry, prices of the antidepressant drugs examined converge. Prices of higher quality antidepressants continue to increase thereafter, eventually becoming the highest priced drugs in the therapeutic class. These findings are consistent with a market in which product differentiation is modest and consumers learn which drug works best for them through experience.     

Health care reform: current updates and future initiatives for ambulatory care nursing

While the signing of the Patient Protection and Affordable Care Act was a historical event marking the beginning of health care reform in the United States, it signaled the start of a golden age for ambulatory care nursing. Ambulatory care RNs are well-positioned to fully participate in health care reform initiatives. RNs are well-positioned to lead, facilitate, and/or participate in all patient care medical homes' and accountable care organizations' quality and safety initiatives through enhanced use of major ambulatory care RN role dimensions such as advocacy, telehealth, patient education, care coordination and transitional care, and community outreach. RNs are also well-positioned to provide patient-centered care, coordinate care, and manage transitions across ambulatory care settings. For the golden age of ambulatory care nursing to become a reality, initiatives surrounding competencies, education modules, and leadership must be addressed immediately.     

Quality indicators for academic nursing primary care centers

ANCs, by definition, deliver more than clinical services to patients and communities. The unique identifier that separates ANCs from other primary care/ambulatory care centers is the educational service they offer to students and other faculty in the school of nursing to which they belong. Therefore, measuring the quality of an ANC must include a measurement of the educational properties that it possesses in addition to the usual quality measurements by such organizations as AAAHC, JCAHO, CHAP, and AAACN. Unless these properties are included and measured by an ANC, it becomes difficult to justify the existence of such a clinic within a school of nursing. ANCs are encouraged to develop quality evaluation programs aimed at evaluating the educational aspects as well as the administrative and clinical aspects of their operations.     

Ambulatory care nursing: growth as a professional specialty

Ambulatory care nursing has emerged as a distinct professional nursing specialty. Many characteristics differentiate ambulatory care nursing from other specialty practices, including the settings, the characteristics of the patient encounters and the focus upon groups, communities, and populations, as well as individual patients and their families. A conceptual framework for ambulatory care nursing was developed in 1998 and recently revised, through consensus of leaders in the specialty. The key elements of the Ambulatory Care Nursing Conceptual Framework are the patient, the environment (both internal and external), and the nurse, practicing in three major roles.     

End-of-life care in nursing homes: the high cost of staff turnover

Nursing home staff turnover results in high cost--both economic and personal--and has a negative impact on the quality of care provided to residents at the end of life. Reducing staff turnover in nursing homes would benefit both the cost to the U.S. health care system, and, most importantly, the care residents receive in the vulnerable period leading to death. There is rising pressure on nursing homes to improve their palliative and end-of-life care practices and reduce transfers to hospital for situations and conditions that can be safely managed on site. Nursing care staff deserve an investment in the specific training necessary for them to give the highest quality care to dying residents. This training should be multifaceted and include the physiological, psychological, spiritual, interpersonal, and cultural (including ethnic) aspects of dying. Empowerment with these necessary knowledge, skills, and attitudes will not only result in better care for residents but likely also will reduce the burnout and frustration staff experience in caring for residents near death.     

A model for testing the relationship of nursing care and patient outcomes

Studying patient outcomes alone may not provide enough information to determine the associated factors that must be improved when the desired patient outcomes are not achieved. The purpose of this correlational study was to investigate the effects of perceived quality of nursing care and coordination of care on patients' comfort, satisfaction, and length of hospital stay. The overall model-data fit was good according to four indices: the chi-square value, goodness of fit index, adjusted goodness of fit index, and the Steigers root square error of approximation. The proposed model, effects of care quality on patient outcomes, was tested. The relationship between quality of nursing care and the proposed outcomes was tested. The results provide important information to the nursing profession and policymakers in meeting patient care needs.     

Pricing Lives: International Guideposts for Safety

Government agencies throughout the world use the value of a statistical life (VSL) to monetise the mortality risk reduction benefits of government policies. The most reliable empirical estimates of the VSL using US labour market data are about US$10 million (year 2015 US dollars). Based on international estimates of the income elasticity of the VSL, one can transfer these values to other countries, leading to my VSL estimate for Australia of US$7.9 million, or A$10.0 million, which is over double the current Australia best‐practices value. Transferring US VSL estimates to other nations after accounting for income differences will boost global VSL estimates. Potential refinements of the VSL based on age and income are also feasible. The VSL could serve a pivotal role in promoting safety by valuing lives in litigation contexts, regulatory sanctions, and corporate risk analyses.     

A transparency and accountability framework for high-value inpatient nursing care

Transparency and accountability are terms that typically refer to activities aimed at measuring and holding providers responsible for their performance through such vehicles as public disclosure of comparative results. Today, transparency and accountability policies are widely accepted strategies to drive quality improvement and stimulate consumer choice. Yet nursing, the single largest health care profession, has not yet been engaged in these policy directions nor considered in their design or implementation. The framework reported here offers nurses and their professional organizations a model for which to advocate for policy change. Hospital and health system executives who have the freedom to establish institutional policies might implement this framework to achieve higher value. This framework provides both the context and components of a system that, if implemented, would measure, report, and reward hospital nursing's contributions to high value.     

Pricing the environment: a critique

A distinction is drawn between opportunity cost and willingness to pay (wtp) approaches to valuing the environment. Wtp is the appropriate measure in situations where there is no prior commitment to environmental standards, otherwise opportunity cost measures apply. Wtp would not normally or properly be used to formulate environmental standards. For a wide range of environmental attributes, where the conditions of direct perception of the environmental problem do not hold, meaningful expressions of wtp cannot be obtained. In these circumstances the underlying model of the Pigovian externality which leads to attempts to measure wtp is inapplicable. While a decision rule based on wtp could still be used it possesses no welfare significance. The critique has implications for sustainability when defined to require trade-offs between natural and person-made capital. Sustainability is practically achieved by developing a set of environmental standards.     

Pricing the Groove: hedonic equation estimates for rare vinyl records

ABSTRACT

This contribution adds to the economic literature on the market value of rarity in markets for cultural collectible goods by studying the price of rare audio recordings (chiefly vinyl) sold on the online marketplace Discogs. Community-based variables serve as proxies for (inverse) rarity and (potential) demand. Results show that the elasticity of price with respect to our measure of inverse rarity (demand) ranges between ?0.120 and ?0.140 (0.150 and 0.160). In addition, effects of hedonic characteristics such as the popularity or collectibility of an artist can be identified. Finally, the study provides evidence for premia for rarity at the top end of the distribution of prices.     

A nurse-run business to improve health care for nursing home residents

The costs of health care for the rapidly growing segment of our population over age 75 are staggering. EverCare is a nurse-run business that seeks to improve cost-effectiveness and quality of health care for nursing home residents enrolled in a health maintenance organization.