Healthcare costs in psoriasis and psoriasis sub-groups over time following psoriasis diagnosis

Aims: To quantify healthcare costs in patients with psoriasis overall and in psoriasis patient sub-groups, by level of disease severity, presence or absence of psoriatic arthritis, or use of biologics.

Methods: Administrative data from Truven Health Analytics MarketScan Research Database were used to select adult patients with psoriasis from January 2009 to January 2014. The first psoriasis diagnosis was set as the index date. Patients were required to have ≥6 months of continuous enrollment with medical and pharmacy benefits pre-index and ≥12 months post-index. Patients were followed from index until the earliest of loss to follow-up or study end. All-cause healthcare costs and outpatient pharmacy costs were calculated for the overall psoriasis cohort and for the six different psoriasis patient sub-groups: (a) patients with moderate-to-severe disease and mild disease, (b) patients with psoriatic arthritis and those without, and (c) patients on biologics and those who are not. Costs are presented per-patient-per-year (PPPY) and by years 1, 2, 3, 4, and 5 of follow-up, expressed in 2014?US dollars.

Results: A total of 108,790 psoriasis patients were selected, with a mean age of 46.0 years (52.7% females). Average follow-up was 962 days. All-cause healthcare costs were $12,523 PPPY. Outpatient pharmacy costs accounted for 38.6% of total costs. All-cause healthcare costs were highest for patients on biologics ($29,832), then for patients with psoriatic arthritis ($23,427) and those with moderate-to-severe disease ($21,481). Overall, all-cause healthcare costs and outpatient pharmacy costs presented an upward trend over a 5-year period.

Conclusions: Psoriasis is associated with significant economic burden, which increases over time as the disease progresses. Patients with moderate-to-severe psoriasis, those with psoriatic arthritis, or use of biologics contributes to higher healthcare costs. Psoriasis-related pharmacy expenditure is the largest driver of healthcare costs in patients with psoriasis.     

Health care utilization analysis with today's information technology

Health care utilization information is an essential resource for the benefits manager. To be meaningful, the data must be easily accessible and available on a timely basis.     

The effect of the federal Family and Medical Leave Act upon employee benefits

FMLA will substantially influence the administration of employee benefits. The plan sponsor, trustees, plan administrator and collective bargaining parties must make a number of policy decisions. These include employer reporting and contribution procedures, settlement of eligibility questions, delinquency procedures, coordination with COBRA, substitution of vacation and sick leave rights and procedures, restrictions on participants working during leave, procedures for the non-forfeiture of accrued benefits and restoration of benefits. After the policy decisions are made and the procedures are established, the proper notices and caveats must be communicated to plan participants, and the plan must update the SPD. Each of the policy decisions, administrative procedures and participant communications must be carefully thought out before implementation. Plan sponsors, trustees and plan administrators should seek the help, advice and assistance of the plan's professional advisers.     

The short-run and long-run benefits of environmental improvement

The social value of a nonmarginal improvement to amentities is not related to hedonic prices in a simple way. Furthermore, hedonic price data do not completely reveal preferences. In order to evaluate short-run benefits of an improvement, the rate of change of the hedonic price function must be normalized by a ratio of population densities. To calculate long-run benefits of the improvement one must calculate the responsiveness of population densities to the nonmarginal improvement. A technique to do so is suggested.     

基于可持续发展视角的企业社会责任思考

企业社会责任问题是企业发展必须面对的重要问题。急功近利的短期行为不利于企业的可持续发展。履行相应的社会责任既是企业实现持续发展的途径,也是构成企业可持续发展的重要内容。企业承担社会责任有助于实现经济利益和社会利益的统一,有助于提升其社会地位和竞争力。发挥政府的引导作用,健全相关法律制度,完善公司治理结构,增强社会的监督作用,建立统一的社会责任标准体系,是强化企业社会责任的重要选择。     

Same-sex spousal benefits: a Canadian perspective

Employers considering same-sex spousal benefits for employees based in Canada must deal with a number of unanswered questions. Some plan sponsors may make benefits coverage decisions based on personal or corporate beliefs or in response to employee demands.     

Pensions with endogenous and stochastic fertility

This paper studies the design of a pay-as-you-go social security system in an overlapping generations model where fertility is in part stochastic and in part determined through capital investment. If investments are publicly observable, pension benefits must be linked positively to the level of investment, and payroll taxes negatively to the number of children. The outcome is characterized by full insurance with all parents, regardless of their number of children, enjoying identical consumption levels. Without observability, benefits must increase, and payroll taxes decrease, with the number of children. The second-best level of investment, and the resulting average fertility rate, are less than their corresponding first-best levels.     

强化农村药店药学服务的对策

通过对农村药店药学服务的现状分析,提出规范和明确农村药店药学服务的内容、强化对零售药店营业员的管理和培训、建立相对完善的药学服务规范、建立标准化的药学服务流程、加强药店药学服务绩效考核与评价等相应策略,促进农村药店药学服务的开展,以实现农村百姓用药的安全、有效、经济合理,推动基层卫生服务事业发展和完善。     

Partial unemployment insurance benefits and the transition rate to regular work

In Finland, unemployed workers who are looking for a full-time job but take up a part-time or very short full-time job may qualify for partial unemployment benefits. In exchange for partial benefits, these applicants must continue their search of regular full-time work. This study analyzes the implications of working on partial benefits for subsequent transitions to regular employment. The timing-of-events approach is applied to distinguish between causal and selectivity effects associated with the receipt of partial benefits. The results suggest that partial unemployment associated with short full-time jobs facilitates transitions to regular employment. Also part-time working on partial benefits may help men (but not women) in finding a regular job afterwards.     

我国农业水权制度改革探讨

通过对我国农业用水现状的经济学分析和国外水权制度安排的研究,指出中国作为农业大国在引进水市场机制的过程中,更应重点关注农业水权制度的改革和切实保障农民利益;同时在借鉴国外水权制度的基础上结合我国农业水权的实际,提出了我国农业水权制度改革的若干思考和建议。     

医疗服务递送机制中主体利益关系及扭曲矫正——基于政府职能的视角

医疗服务递送机制中涉及到医疗服务机构、医生、药企和患者四方利益主体。当前我国这些利益主体之间种种不合理的利益"合作"与"冲突",均与医疗服务递送机制中政府职能的缺位和错位存在着直接关系。在进一步深化医改的过程中,我国政府应当正确地履行好理应承担的公共职能,即加强对卫生资源的合理规划与配置;加大对公立医院的财政投入并优化对其补偿机制;加强对医疗服务机构与药品行业的监管;加强医药信息披露机制建设;鼓励医药卫生服务市场公平竞争,并放弃不适当的医药价格管制。     

社会主义新农村建设中农民利益表达机制的创新

社会主义新农村建设中,农民利益表达显得光为重要,它是保证社会公正的必要条件,是政府正确决策的前提和基础,同时还是社会稳定的安全阀.由于当前我国农民所拥有资源相对不足,农民在利益表达中尚存在不少问题.在构建和谐社会重要时期,创新农民利益表达机制成为必须;加速农村生产力的发展,促进农村经济繁荣,为农民有效的利益表达提供物质基础;引入协商民主的治理模式,创新农民利益表达的制度平台;改革和完善原有的农民利益表达渠道;允许农民利益集团的形成并实现利益表达,使各种利益在竞争和博弈中实现均衡;培育新型公民文化,形成农民理性利益表达的精神文化支撑,都有利于提高农民利益表达的理性和有效程度.     

Taxes,Retirement Transfers,and Annuities*

In most countries, retirement benefits from pension saving must be taken as an annuity. By contrast, Australia allows benefits to be taken as a lump sum, and instead has recently introduced various tax incentives to encourage annuity purchase. This paper investigates the effectiveness of these tax concessions, and concludes that they do little to achieve this objective This is because they are nullified by the provisions of the broader tax and social security framework within which Australian private pension policy is set     

Policy Framework for Transition to a Low-Carbon World Economy

Climate change mitigation policy is the most difficult to come before our polity in living memory. There can be no solution without international agreement involving all substantial economies, and yet each country has an incentive to free ride on others. The international agreement must have five parts: agreement on the objective in terms of concentrations of greenhouse gases in the atmosphere, agreement on allocation of an emissions entitlements budget among countries, agreement on rules for international trade in entitlements, agreement on developed countries taking the lead on development of low-emissions technologies, and agreement on assistance from developed countries for climate change mitigation in developing countries. Two sources of market failure must be corrected to achieve emissions reduction targets efficiently: the external costs of emitting greenhouse gases and the external benefits of private investment in innovation in relation to low-emissions technologies.     

Economic policy implications of the implementation of the single European currency

As it is well known, before the next century a single European currency, the Euro, will be introduced and European products will enjoy an extensive market. Economists have focused their attention on analyzing the different costs and benefits derived from the implementation of the single currency. With regard to the benefits of such an implementation, the most important ones are as follows. The introduction of a single currency will encourage internal demand and will help economic agents save transaction costs; labor distribution will improve; there will be less uncertainty in the markets; and, lastly, it will improve economic growth if technical transmission is facilitated. But there are also problems in the implementation of the single European currency. Credit institutions, especially banks and savings banks, will lose their income from the currency exchange process. It must also be considered that the economies will depend on the higher development level of the German economy. The goal of this paper is to analyze the costs and benefits derived from the implementation of a single currency.     

Unemployment insurance design: Inducing moving and retraining

Evidence suggests that unemployed individuals can affect their job prospects by undertaking a costly action like deciding to move or retrain. Realistically, such an opportunity only arises for some individuals and the identity of those may be unobservable ex ante. The problem of characterizing constrained optimal unemployment insurance in this case has been neglected in previous literature. We construct a model of optimal unemployment insurance where multiple incentive constraints are easily handled. The model is used to analyze the case when an incentive constraint involving moving costs must be respected in addition to the standard constraint involving costly unobservable job-search. Absent wealth effects on behavior, we derive closed-form solutions showing that when the moving/retraining incentive constraint binds, unemployment benefits should increase over the unemployment spell, with an initial period with low benefits and an increase after this period has expired.     

THE WAIVER PORK BARREL: COMMITTEE MEMBERSHIP AND THE APPROVAL TIME OF MEDICAID WAIVERS

Recent growth in Medicaid spending has forced states to look for ways to slow the program's rate of growth. Under the Medicaid program's rules, state governments must submit a waiver to the federal government in order to implement a cost-saving program. The time required to process a waiver varies from 14 days to over three years. This study examines the determinants of the time it takes to process a waiver and the number of revisions required before final approval. The results indicate that an increase in the tenure of the state's delegation to the House oversight committee reduces the time to approval for Freedom of Choice waivers. However, more liberal committee members appear to delay waivers. The results complement the existing literature on the pork barrel by showing that seniority on a committee is an important determinant-not only of monetary benefits but also of nonmonetary benefits. ( JEL H51, 118)     

Mail-order pharmacy use and medication adherence among Medicare Part D beneficiaries with diabetes

Abstract

Objective:

To examine medication adherence among Medicare Part D beneficiaries initiating oral anti-diabetic medications and explore whether there is any association of using mail-order pharmacy (vs. retail pharmacy) with better adherence in this patient population.

Research design and methods:

Using administrative pharmacy claims data, we conducted a retrospective cohort study on Medicare Part D beneficiaries who newly initiated oral anti-diabetic treatment between July 1, 2008 and December 31, 2008. Mail-order pharmacy users were matched to retail pharmacy users via propensity scoring, controlling for patient demographic and clinical characteristics. Adherence with oral anti-diabetic medications during the benefit year of 2009 was assessed using the proportion of days covered (PDC). Comparison of medication adherence between the mail-order pharmacy group and retail pharmacy group was conducted in the propensity matched sample using the paired t-tests and McNemar’s tests.

Results:

A total of 22,546 patients who initiated oral anti-diabetic medications were identified. The average PDC was 0.60 and only 41.6% of the study population attained good adherence (defined as PDC?≥?0.8) with oral anti-diabetic medications during calendar year 2009. The matched sample included 1361 patients in each of the mail-order and retail pharmacy cohorts. Compared with the retail pharmacy group, mail-order pharmacy users demonstrated a significantly higher PDC (0.68 vs. 0.61; P?<?0.001) throughout the benefit year. More patients in the mail-order pharmacy group (49.7%) attained good adherence with their oral anti-diabetic medications compared to 42.8% in the retail pharmacy group (P?<?0.001).

Limitations:

The study was subject to limitations inherent in retrospective claims database analysis.

Conclusions:

Adherence with oral anti-diabetic medications among Medicare Part D beneficiaries is suboptimal. Patients using mail-order pharmacy had better adherence to oral anti-diabetic medications than those who used retail pharmacies. However, the causal relationship between mail-order pharmacy use and adherence should be further examined in a randomized study setting.