Hospice costs and medicare reimbursement: an application of break-even analysis

The adequacy of Medicare reimbursement to cover hospice costs is examined using break-even analysis. Since hospice costs are high during the first few days after enrollment, a long period of enrollment is required for per diem reimbursement to cover costs. Under a variety of specifications, the length of stay required for the hospice to break even is greater than the median length of stay.     

Palliative care: a paradigm of care responsive to the demands for health care reform in America

Palliative care is poised to become a universally available approach to health care which addresses both the needs of patients and families experiencing serious, progressive, and life-threatening illness, and also the costs of delivering such needed services. Palliative care and hospice are part of a continuum of care with palliative care provided at any time during the illness trajectory, while hospice care is offered at the end of life. Within the context of health care reform, we believe palliative care addresses critical economic imperatives while enhancing quality of life even as death approaches. As leaders in health care, advance practice nurses, specifically, and the nursing community in general are best positioned with the knowledge, expertise, and commitment to advance the specialty of palliative care and lead the way in the reform of America's health care system.     

A cost-benefit analysis of music therapy in a home hospice

Medicare's fixed daily rates create an absolute cost constraint on hospices; consequently, the growth in hospice brings financial pressures. The patient efficacy of music therapy has been demonstrated in the literature and includes improving pain, agitation, disruptive behaviors, communication, depression, and quality of life. Music therapy is well suited to hospice as it addresses the four domains of palliative care (physiological, emotional, social, and spiritual care). In this small study, the total cost of patients in music therapy was $10,659 and $13,643 for standard care patients, resulting in a cost savings of $2984. The music therapy program cost $3615, yielding a cost benefit ratio of 0.83. When using cost per patient day, the cost benefit ratio is 0.95.     

'Affordable' death in the United States: an action plan based on lessons learned from the Nursing Economic$ special issue

An eight-point action plan is proposed for lowering costs associated with end-of-life health care in the United States, as well as improving the quality of life experienced by patients and their families. This action plan was derived from an analysis of the six articles presented in this special issue of Nursing Economic$. The two major features of this action plan are: (a) expansion of hospice and palliative care, as well as (b) increased use of advance directives. Additionally, as pre-conditions for the effective operation of this action plan, the political, cultural, and legislative contexts that merit attention are discussed. Finally, arguments as to the desirability, feasibility, and sustainability of this action plan are offered.     

Local television,citizen knowledge and U.S. senators' roll-call voting

I study the effect of access to local television on citizens' political knowledge. I do so by utilizing the mismatch between U.S. television markets and state borders, causing some citizens to receive local television which primarily covers neighboring state politics. I find that access to relevant local television causes citizens to be more informed about their senators' roll-call votes, and more likely to hold opinions about these senators. I also find that citizens with access to relevant local television are more likely to assess their senators based on how well the senators' roll-call votes align with the citizens' policy preferences. These results suggest that passively acquired information through television can help individuals evaluate their elected representatives.     

The burden of illness of hepatorenal syndrome (HRS) in the United States: a retrospective analysis of electronic health records

Objectives: Hepatorenal Syndrome (HRS) is characterized by renal failure in patients with advanced chronic liver disease (CLD) and is the leading cause of hospitalizations in CLD. This study examines the clinical and economic burden, outcomes, and unmet need of HRS treatment in US hospitals.

Method: A retrospective cohort study was conducted based on a large electronic health records database (Cerner HealthFacts) with records for hospitalized HRS patients from January 2009–June 2015. Demographics, clinical characteristics, treatment patterns, and economic outcomes were analyzed. Prognostic indicators of cirrhosis, kidney injury, end-stage liver disease, and acute-on-chronic liver failure were used to determine mortality risk.

Results: A total of 2,542 patients hospitalized with HRS were identified (average age = 57.9 years, 61.8% males, 74.2% Caucasian), with an average total hospital charge of $91,504 per patient and a mean length of stay (LOS) of 30.5?days. The mortality rate was 36.9% with 8.9% of patients discharged to hospice. Of all patients, 1,660 patients had acute kidney injury, 859 with Stage 3 disease, and 26.7% had dialysis. The 30-day readmission rate was 33.1%, 41% of which were unplanned. Nearly one-third of study patients had commercial insurance (30.2%), followed by Medicare (29.9%); hospital charges varied by LOS, receipt of dialysis, and discharge status. Regression analysis demonstrated that HRS costs are associated with LOS, dialysis, and hospital mortality.

Conclusion: HRS is associated with poor outcomes and high hospital costs. Analysis of HRS cost drivers demonstrated an unmet need for additional treatment options to improve outcomes in this patient population.     

直接投资引致的美中贸易逆差:经验研究

运用基于误差修正模型的格兰杰因果关系检验模型,在商品分类层面研究关中贸易逆差与关国对华直接投资的内在联系。结果显示：从长期和短期来看,中国制成品的出口都是关中贸易逆差的“因”,中国制成品的出口与关国对华直接投资之间具有显著的双向格兰杰因果关系,因此关国进入中国的FDI,尤其是进入制造业的FDI越多,美中贸易逆差就越大;美中贸易逆差是结构性的,它不仅不会在短期内消除,而且会随着美国劳动密集型产业向中国的进一步转移而加剧。     

U.S. farm dynamics and the distribution of U.S. agricultural subsidies

The persistent instability of the agricultural sector is the fundamental premise of most agricultural policy. Yet no research has ever quantified the aggregate dynamics of individual farms in the US. This article is the first to combine the US Census of Agriculture with the Agricultural Resource Management Survey to observe the dynamics of nearly 1.5 million farms. The data reveal substantial variation in farm size expansion and contraction. Most of this variation is unobservable in the sector totals reported by the US Department of Agriculture each year. The distribution of agricultural subsidies suggests that subsidies become more important as farms get smaller and may play a role in slowing farm size contraction.     

The curse of natural resources: An empirical investigation of U.S. counties

Research consistently shows that natural resource dependence tends to be associated with lower economic growth. However, the studies typically focus on differences across nations or states. We fill a gap in the literature by testing the so-called resource curse at a more disaggregated county level. Our results show clear evidence that resource-dependent counties exhibit more anemic economic growth, even after controlling for state-specific effects, socio-demographic differences, initial income, and spatial correlation. A case study analysis of Maine and Wyoming, and the counties within, highlight the growth effects of specializing in natural resource extraction.     

Journey to Magnet: cost vs. benefits

As hospitals and health systems strive to be an "Employer of Choice", one important goal for their nursing leaders has been the decision to embark on their journey of becoming a designated Magnet facility. Approximately 12 months ago, conversations with a few chief nursing executives uncovered a hot topic concerning the achievement/designation of Magnet status and specifically its cost benefits. With more and more hospitals obtaining Magnet status, these nurse leaders did not know how other organizations felt about their journey including outcomes and were very interested in learning more details about their colleagues' experiences.     

Enriching U.S. labor results in a multi-regional CGE model

This paper proposes a new approach for enriching results for U.S. labor markets from the leading multi-regional CGE model, the GTAP model. Departing from the usual approach of expanding labor data in all economies in a model's database, our method expands only the U.S. labor data. Additionally, we introduce a novel modification to primary factor demands, generating more realistic labor markets in which lower-skilled jobs substitute more easily with other primary factors than higher-skilled jobs. The advantages of our approach are that we can rely on the most recent and the most disaggregate U.S. labor data available; we build upon the most recently available GTAP database; and, when applied to other economies, our approach is the initial contribution to a database of detailed labor statistics for several economies.     

International Economics in U.S. High Schools: Results from a National Survey

A national survey of high school teachers revealed interest in, and support for, instruction on international concepts, issues, and institutions, with teachers of economics supporting free-trade policies more than other social studies teachers.     

Believers vs. deniers: Climate change and environmental policy polarization

This paper theoretically studies the consequences of partisanship with an application to environmental policy. We model an election between a right-wing and a left-wing candidate who strategically propose environmental policies to gain the support of an electorate divided based on their climate change beliefs and productive assets. While environmental regulations imply a trade-off between a more sustainable environment and higher incomes for all voters, climate change believers have a higher belief in human activity-induced climate change, which translates into greater expected environmental benefits from policy, and high-asset voters care relatively more about mitigating economic costs. Voters view the left-wing candidate as more effective in addressing environmental challenges, whereas her right-wing opponent is the better candidate to deliver relief from the economic burden of regulations. In equilibrium, there exists policy divergence and the right-wing candidate always proposes the more pro-industry policy. We find that higher asset inequality moves equilibrium policies in a pro-industry direction as long as high-asset voters are ideologically more homogeneous than low-asset ones. Equilibrium policies become further polarized with greater partisanship as those voters with the same climate change belief hold similar ideologies.     

Is H.A. Simon a theoretician of decentralized planning? A comparison with F.A. Hayek on planning,market, and organizations

Herbert A. Simon acknowledged Friedrich A. Hayek as a founder of the notion of bounded rationality; yet Simon considered Hayek’s perspective incomplete, and, more in general, their views on market mechanisms, planning, and organization exhibit considerable differences. The comparison between these authors sheds light on Simon’s interpretation of planning, which emerges within his theory of organization (and not in traditional debates on socialism). Contrary to Hayek, he maintained that planning, in specific circumstances, is more advantageous than the market; and in both administration and organization, it involves a decentralized structure based on near independent sub-units. Decentralization of decisions also appears in social planning, which evolves through continuous interactions among planners (i.e., agents and institutions), and it is a process connoted by the absence of “fixed goals”. Finally, Simon defined modern economies more in terms of “organizational economies” than in those of “market economies” and this highlights a further difference with respect to the Austrian economist. This leads to analysis of the nature of organizations as hierarchical and “near-decomposable” structures, which refers to Simon’s theory of complexity and gives an epistemological explanation to the relation between centralization and decentralization.     

Hierarchy vs. partnership

Simple organizations, composed of operatives and one manager, may be organized as a hierarchy with the manager appropriating all profits or as a partnership with (say) equal shares of profits. Conditions on profitability and the optimal span of control are analyzed. Next, partnerships are considered and alternative incentives and distributions are compared. When partners are free to choose their time inputs, then a sufficiently high preference for leisure as against income will make a partnership more attractive even though it is less profitable.     

U.S. Universal Health Coverage at a Crossroad

Scheduled for 2014, implementation of universal coverage in the U.S. is not proceeding smoothly. Embroiled in bitter partisan conflict and absent decisive popular support, this costly new entitlement program, The Affordable Care Act commonly referred to as ObamaCare, is vulnerable to a major overhaul or possible rejection. National interest considerations urge that reformulation center on better matching the law’s aspirations with new realities rather than abstract ideals. Constraints on government spending and the risks public indebtedness pose for the national economy compel a pragmatic reassessment of entitlement policy in the light of what is affordable. ObamaCare compounds the government’s unsustainable debt and deficit problem, promising benefits that are overly generous and lack effective cost controls. Fiscal imperatives compel that scarce government resources be targeted on the truly needy and that individuals capable of doing so assume a greater responsibility for their health care. They also necessitate a more sophisticated public-private partnership than provided in the new health law in order to capture the benefits of market competition that facilitate innovation, circumvent political stalemate, confine the inflationary effects of services perceived to be free goods, and provide incentives that reward individuals for becoming more cost-conscious users of health services. Finally, the harnessing of self-interest is presented as a superior alternative to centralized command and control methods for influencing health behavior and keeping health spending under control. In the interest of economy and efficiency, government involvement, following the subsidization of low income persons on a sliding scale basis, should concentrate on standard setting, monitoring and evaluating productivity and quality improvement practices. Ultimately, living standards contribute more to health status than do health services, and this requires investment directed at economic growth.     

Against the stand-alone-cost test in U.S. freight rail regulation

The stand-alone-cost test has become an expensive, extensive, and time-consuming component of the regulatory practice of the U.S. Surface Transportation Board in the performance of its statutory duty to protect “captive shippers” from monopoly rail rates. A close examination of the history of its adoption and application suggests only a tenuous connection with its claimed intellectual foundations. It is time to retire this notion and replace it with something simpler and more effective and transparent.     

GROWTH,INEQUALITY, AND ECONOMIC FREEDOM: EVIDENCE FROM THE U.S. STATES

This article returns to the discussion of how income inequality affects economic growth. The main argument of the article is that economic freedom is likely to mediate the association between inequality and growth. In a panel of 300 observations from six 5‐year periods across the 50 U.S. states, I employ five different measures of inequality. The results show that across measures, the growth effects of inequality turn more positive with more economic freedom. The moderating effects are mainly driven by measures of public sector consumption. (JEL O11, O38, O43, P48)     

Labour Market Structure and Inequality: A Comparison of Italy and the U.S.

Markets with rigid labour regulations and centralized wage setting are often thought to be inefficient but egalitarian. Using a model of off-and on-the-job search and event-history, individual-level data for Italy and the U.S., we show that while the cross-sectional wage distributions of young Italian males are much more compressed than are the comparable distributions for young white U.S. males, the estimated search model implies that the distribution of lifetime welfare is no more disperse in the U.S. than it is in Italy. Our model implies that the high frequency of movements between labour market states leads to both a relatively equitable distribution of "long run" welfare in the U.S. and a high level of cross-sectional inequality.