Cost Trends in Land Grant Colleges and Universities

Thisis a study of the production and cost relationships in the Land Grant Colleges and Universities for the period 1956–57 to 1962–63. The study is based upon financial, enrolment, and employment data as published by the U.S. Office of Education (Lind, 1959–65). The results show few significant changes in the production relations, but rapid increases in factor costs have resulted in great increases in the social costs of educating students. These results are important, both for national educational policy and planning on the level of the individual college or university.     

An economic evaluation of perioperative enteral nutrition in patients undergoing colorectal surgery (SANICS II study)

Aims: The objective of this (trial based) economic evaluation was to assess, from a societal perspective, the cost-effectiveness of perioperative enteral nutrition compared with standard care in patients undergoing colorectal surgery.

Materials and methods: Alongside the SANICS II randomized controlled trial, global quality-of-life, utilities (measured by EQ-5D-5L), healthcare costs, production losses, and patient and family costs were assessed at baseline, 3?months, and 6?months. Incremental cost-effectiveness ratios (ICERs) (i.e. cost per increased global quality-of-life score or quality-adjusted life year [QALY] gained) and cost effectiveness acceptability curves were visualized.

Results: In total, 265 patients were included in the original trial (n?=?132 in the perioperative enteral nutrition group and n?=?133 in the standard care group). At 6?months, global quality-of-life (83 vs 83, p?=?.357) did not differ significantly between the groups. The mean total societal costs for the intervention and standard care groups were €14,673 and €11,974, respectively, but did not reach statistical significance (p?=?.109). The intervention resulted in an ICER of –€6,276 per point increase in the global quality of life score. The gain in QALY was marginal (0.003), with an additional cost of €2,941, and the ICUR (Incremental cost utility ratio) was estimated at €980,333.

Limitations: The cost elements for all the participating centers reflect the reference prices from the Netherlands. Patient-reported questionnaires may have resulted in recall bias. Sample size was limited by exclusion of patients who did not complete questionnaires for at least at two time points. A power analysis based on costs and health-related quality-of-life (HRQoL) was not performed. The economic impact could not be analyzed at 1?month post-operatively where the effects could potentially be higher.

Conclusions: This study suggests that perioperative nutrition is not beneficial for the patients in terms of quality-of-life and is not cost-effective.

Trial registration: ClinicalTrials.gov identifier: NCT02175979.

Trial registration: Netherlands National Trial Register identifier: NTR4670.     

Comparison of hospital length of stay and hospitalization costs among patients with non-valvular atrial fibrillation treated with apixaban or warfarin: An early view

Objective: To quantify and compare hospital length of stay (LOS) and costs between hospitalized non-valvular atrial fibrillation (NVAF) patients treated with either apixaban or warfarin via a large claims database.

Methods: Adult patients hospitalized with AF were selected from the Premier Perspective Claims Database (01JAN2013-31MARCH2014). Patients with evidence of valvular heart disease, valve replacement procedures, or pregnancy during the index hospitalization were excluded. Patients treated with apixaban or warfarin during hospitalization were identified. Propensity score matching (PSM) was performed to control for baseline imbalances between patients treated with apixaban or warfarin. Primary outcomes were hospital LOS (days), post-medication administration LOS, and index hospitalization costs, and were compared using paired t-tests in the matched sample.

Results: Before PSM, 2894 apixaban and 124,174 warfarin patients were identified. Patients treated with warfarin were older and sicker compared to those treated with apixaban. After applying PSM, a total of 2886 patients were included in each cohort, and baseline characteristics were balanced. The mean (standard deviation [SD] and median) hospital LOS was significantly (p?=?0.002) shorter for patients treated with apixaban for 5.1 days (5.7 and 3) compared to warfarin for 5.5 days (4.8 and 4). The trend appeared consistent in the hospital LOS from point of apixaban or warfarin administration to discharge (4.5 vs 4.7 days, p?=?0.051). Patients administered apixaban incurred significantly lower hospitalization costs compared to those administered warfarin ($11,262 vs $12,883; p?<?0.001).

Conclusions: Among NVAF patients, apixaban treatment was associated with significantly shorter hospital LOS and lower costs when compared to warfarin treatment.     

Resource utilisation,charges and mortality following hospital inpatient admission for congestive heart failure among the elderly in the US

Abstract

Objectives: This study examined resource utilisation, charges and mortality among congestive heart failure (CHF) patients over the course of the first year following initial hospital discharge for CHF in the US.

Methods: The Medicare Standard Analytic Files for the years 1998 through to 2001 were used for the analysis. The study sample included patients with an inpatient hospitalisation between the 1st January 1999 and the 31st December 2000 with a primary ICD-9 diagnosis code of CHF. Statistical analysis including univariate and multivariate regression analysis were conducted.

Results: Within 1 year following initial CHF discharge, 50% of patients had at least one all-cause readmission and 20% had at least one CHF-related readmission. The mean total charges among all patients was $36,230 (sd $55,086). Of the patients 20% incurred more than $55,000 in medical charges during the year after discharge; 10% incurred charges exceeding $90,000. More than one-half of the CHF patients visited the emergency department within 3 months of hospital discharge, and within 1 year almost one-third of the CHF patients (31.4%) died.

Conclusions: The charges, morbidity and mortality associated with CHF patients are significant. Reducing these risks through more effective disease management offers the potential for substantial cost savings.     

Impact of treatment with liposomal bupivacaine on hospital costs,length of stay,and discharge status in patients undergoing total knee arthroplasty at high-use institutions

Aims: Post-surgical pain experienced by patients undergoing total knee arthroplasty (TKA) can be severe. Enhanced recovery after surgery programs incorporating multimodal analgesic regimens have evolved in an attempt to improve patient care while lowering overall costs. This study examined clinical and economic outcomes in hospitals using liposomal bupivacaine (LB) for pain control following TKA.

Methods: This retrospective observational study utilized hospital chargemaster data from the Premier Healthcare Database from January 2011 through April 2017 for the 10 hospitals with the highest number of primary TKA procedures using LB. Within these hospitals, patients undergoing TKA who received LB were propensity-score matched in a 1:1 ratio to a control group not receiving LB. Outcomes included hospital length of stay (LOS), discharge status, 30-day same-hospital readmissions, total hospitalization costs, and opioid consumption; only patients with Medicare or commercial insurance as the primary payer for TKA were considered.

Results: The study population included 20,907 Medicare-insured patients (LB?=?10,411; control =10,496) and 12,505 patients with commercial insurance (LB?=?6,242; control?=?6,263). Overall, LOS was 0.6?days shorter with LB (p?p?P?p?p?Limitations: Costs were estimated using Premier charge-to-cost ratios and limited to goods and services recorded in the chargemaster. Findings from these 10 hospitals may not be representative of other US hospitals.

Conclusions: In a sub-set of 10?US hospitals with the highest use of LB for TKA, LB use was associated with shorter hospital LOS, increased home discharge, lower total hospitalization costs, and decreased opioid use after TKA.     

Hospital cost and length of stay in idiopathic pulmonary fibrosis

Objective: To provide a detailed picture of the economic impact of hospitalization in idiopathic pulmonary fibrosis (IPF) and to identify factors associated with cost and length of stay (LOS).

Methods: In this retrospective cross-sectional study using the Nationwide Inpatient Sample (NIS), this study included hospitalizations for IPF (ICD-9-CM 516.3) with a principal diagnosis of respiratory disease (ICD-9-CM 460-519) from 2009–2011; lung transplant admissions were excluded. Total inpatient cost, LOS, in-hospital death, and discharge disposition were reported. Linear regression models were used to determine variables predictive of LOS and cost.

Results: From 2009–2011, 22,350 non-transplant IPF patients with a principal diagnosis of respiratory disease were admitted: mean (±SE) age was 70.0 (0.32), and 49.1% were female. While in hospital, 11.4% of patients received mechanical ventilation and 8.9% received non-invasive ventilation. Mean (±SE) LOS was 7.4 (0.15) days overall (p?Limitations: The positive predictive value of the algorithm used to identify IPF is not optimal. The NIS database does not follow patients longitudinally, and claims after admission are not available. Claims do not indicate whether listed diagnoses were present on admission or developed during hospitalization. The exclusion of transplant-related expenditures lead to under-estimation of cost.

Conclusion: Using a nationally-representative database, we found IPF respiratory-related hospitalizations represent a significant economic burden with ～7,000 non-transplant IPF admissions per year, at a mean cost of $16,000 per admission. Mechanical ventilation is associated with statistically significant increases in LOS and cost. Therapeutic advances that reduce rates and costs of IPF hospitalizations are needed.     

Information and \sigma -algebras

In this work, we clarify the relationship between the information that an agent receives from a signal, from an experiment or from his own ability to determine the true state of nature that occurs and the information that an agent receives from a $\sigma $ -algebra. We show that, for countably generated $\sigma $ -algebras, the larger it is, the larger the information is. The same is true for general $\sigma $ -algebras after the removal of a negligible set of states.     

Trade,product variety and welfare: a quantitative assessment for mainland China

We calculate a variety of welfare gains for Mainland China, following the approach of Romer (1994 Romer, P. 1994. New goods, old theory, and the welfare costs of trade restrictions. Journal of Development Economics, 43(1): 5–38. [Crossref], [Web of Science ®] , [Google Scholar]), who emphasized that proper modelling of the impact of trade restrictions on the number of available product varieties is crucial for quantifying the welfare impact of trade liberalization. The empirical work presented relies on direct measures of product variety calculated from highly disaggregated trade data. The emerging conclusion is that freer trade has indeed boosted welfare.     

Two Sides of the Same Coin: Re-examining Nepotism and Discrimination in a Segmented Society

Abstract

We report the results from a series of trust games designed to distinguish racial discrimination from racial nepotism, played with a sample of high school students in Cape Town, South Africa. In contrast to the original work in this regard by Fershtman et al. (2005 Fershtman, C., Gneezy, U. and Verboven, F. 2005. “Discrimination and Nepotism: the efficiency of the anonymity rule,”. Journal of Legal Studies, 34: 371–396. [Crossref], [Web of Science ®] , [Google Scholar]), we find considerably greater heterogeneity in the way that proposers respond to the revealed racial identity of their partner, with nepotism being a dominant behavior. However, while some proposers exhibit a nepotistic bias in their offers that favors in-group members on average, others exhibit a nepotistic strategy that favors out-group members. A consequence of this nepotism is that both efficiency and equity are reduced on average.     

Hayek and the General Theory ∗

Abstract

Hayek did not review the General Theory, but he criticized it in Profits, Interest and Investment (1939 Hayek, F. A. 1939. “Profits, interest and investment”. In Profits, Interest and Investment, London: Routledge & Sons.  [Google Scholar]) and in part IV of The Pure Theory of Capital (1941 Hayek, F. A. 1941. The Pure Theory of Capital, Chicago: The University of Chicago Press.  [Google Scholar]). First, he showed that only exceptionally does greater consumption favour investment and employment. Second, he rejected Keynes's liquidity preference and maintained that only in an ‘extreme case’ might it be said that Keynes's theory of the rate of interest is valid. Although he correctly identified the gist of Keynes's theoretical innovation, his criticisms were already implicitly answered in the General Theory.     

Restrictions and identification in a multidimensional risk-sharing problem

We consider $H$ expected utility maximizers that have to share a risky aggregate multivariate endowment $X\in {\mathbb {R}}^{N}$ and address the following two questions: does efficient risk-sharing imply restrictions on the form of individual consumptions as a function of $X$ ? Can one identify the individual utility functions from the observation of the risk-sharing? We show that when $H\ge \frac{2N}{N-1}$ efficient risk sharings have to satisfy a system of nonlinear PDEs. Under an additional rank condition, we prove an identification theorem.     

The effects of railroad development on price convergence among the states of the USA from 1866 to 1906

This study examines the effects of the reduced transaction costs on the price behaviours in the second half of the nineteenth century, where declines in transaction costs were mainly caused by railroad development during this period. It employs a panel test introduced by Levin and Lin (1992 Levin A Lin C 1992 Unit root tests in panel data: asymptotic and finite-sample properties Discussion Paper 92-93 University of California San Diego CA ) on the convergence of wheat and corn prices using a panel of 48 US states from 1866 to 1906. The results show that, by decreasing transportation costs, railroads played an important role in price convergence among states of the USA for wheat and corn during the postbellum period.     

Irving Fisher's debt deflation analysis: From the Purchasing Power of Money (1911) to the Debt-deflation Theory of the Great Depression (1933)

Abstract

In 1933, Irving Fisher proposed an explanation for the Great Depression based on the distinction between the price level and price change effect of deflation in a context of over-indebtedness. This paper compares the debt-deflation theory of Fisher (1933 Fisher, I., 1933. The debt-deflation theory of great depressions, Econometrica 1 (1933), pp. 337–57. DOI: 10.2307/1907327[Crossref], [Web of Science ®] , [Google Scholar]) with the dynamic depression process he had expounded almost 20 years earlier in the Purchasing Power of Money (1911). The role played by both price level and price change effects in the analyses of Fisher (1933, 1911) are clarified in the context of the disequilibrium model of Tobin (1975 Tobin, J., 1975. Keynesian models of recession and depression, American Economic Review 65 (1975), pp. 195–202.[Web of Science ®] , [Google Scholar]). More precisely, we show that the stationary equilibrium is assumed to be locally unstable according to Fisher's 1911 insights and globally unstable according to his 1933 analysis.     

Labour values and energy values: some developments on the common substance of value since 1867

Abstract

Marx’s Das Kapital (1867) singled out labour as the common substance of value in all commodities. Costanza (1980 Costanza, Robert. 1980. “Embodied Energy and Economic Valuation.” Science 210 (4475): 1219–1224. doi:10.1126/science.210.4475.1219[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]) in Science chose energy and propagated energy values (a century after Engels criticised Podolinsky on energy). Mainstream economists quickly questioned Marx’s logic. Pareto advocated simultaneous equations, unaware of their use by Mühlpfordt and Dmitriev. Contributions by Charasoff and Potron were also overlooked. Already in 1927, Leontief and Sraffa knew how to replace labour values by other commodity values. Generalising Sraffa’s subsystems and using “percentage formulas” for price-value deviations, I discuss some empirical results for labour or energy theories of value.     

Will the skill-premium in the Netherlands rise in the next decades?

While the skill-premium has been rising sharply in the US and the UK for 20 years, the Dutch skill-premium decreased for much of that period and only started to rise in the early 90s. In this article, we investigate whether the Dutch skill-premium will rise in the next decades. To answer this question, we forecast the skill-premium using the Katz and Murphy (1992 Katz, L and Murphy, K. 1992. Changes in relative wages, 1963–1987: supply and demand factors. Quarterly Journal of Economics, 107: 35–78. [Crossref], [Web of Science ®] , [Google Scholar]) and the Krusell et al. (2000 Krusell, P, Ohanian, L, Ríos-Rull, J-V and Violante, G. 2000. Capital-skill complementarity and inequality: a macroeconomic analysis. Econometrica, 68: 1029–53. [Crossref], [Web of Science ®] , [Google Scholar]) models. The Katz and Murphy model (KM) explains demand shifts by skill-biased technological change in unobservable variables captured by a time trend. In contrast, the Krusell et al. model (KORV) explains demand shifts by (observable) changes in the capital stock under a capital-skill complementarity technology. The results show that while the KM model predicts that the skill-premium will have increased by 30% in 2020, based on realistic predictions of the stock of capital, the KORV model predicts that the skill-premium will remain between ?5 and +5% of its 1996 level.     

Does PPP hold in African countries? Further evidence based on a highly dynamic non-linear (logistic) unit root test

With a view to investigating whether the purchasing power parity (PPP) theory holds true for selected African countries during the January 1980–December 2003 period, we employ a rigorous, highly dynamic non-linear (logistic) unit root test, as first advanced by Leybourne et al. (1998 Leybourne, S, Newbold, P and Vougas, D. 1998. Unit roots and smooth transitions. Journal of Time Series Analysis, 19: 83–97. [Crossref] , [Google Scholar]), which is considerably more powerful than those tests traditionally used. Compared with the rejection of the null of the unit root process for only one of the 22 countries under study when we use the traditional ADF, PP, KPSS, NP and the DF-GLS unit root tests, with the Leybourne et al. (1998 Leybourne, S, Newbold, P and Vougas, D. 1998. Unit roots and smooth transitions. Journal of Time Series Analysis, 19: 83–97. [Crossref] , [Google Scholar]) test, we strongly reject the null of the unit root process for a surprising six of the 22 countries. These empirical results clearly indicate that PPP holds true for these six countries, namely the Central African Republic, the Côte d’Ivoire, Kenya, Madagascar, Uganda and Lesotho.     

Essential data, budget sets and rationalization

According to a minimalist version of Afriat’s theorem, a consumer behaves as a utility maximizer if and only if a feasibility matrix associated with his choices is cyclically consistent. An “essential experiment” consists of observed consumption bundles $(x_{1}, \ldots , x_{n})$ and a feasibility matrix $\varvec{\alpha }$ . Starting with a standard experiment, in which the economist has access to precise budget sets, we show that the necessary and sufficient condition for the existence of a utility function rationalizing the experiment, namely, the cyclical consistency of the associated feasibility matrix, is equivalent to the existence, for any budget sets compatible with the deduced essential experiment, of a utility function rationalizing them (and typically depending on them). In other words, the conclusion of the standard rationalizability test, in which the economist takes budget sets for granted, does not depend on the full specification of the underlying budget sets but only on the essential data that these budget sets generate. Starting with an essential experiment $(x_{1}, \ldots , x_{n}; \varvec{\alpha }$ ) only, we show that the cyclical consistency of $\varvec{\alpha }$ , together with a further consistency condition involving both $(x_{1}, \ldots , x_{n})$ and $\varvec{\alpha }$ , guarantees the existence of a budget representation and that the essential experiment is rationalizable almost robustly, in the sense that there exists a single utility function which rationalizes at once almost all budget sets which are compatible with $(x_{1}, \ldots , x_{n}; \varvec{\alpha }$ ). The conditions are also trivially necessary.     

Is the CSR Craze Good for Society? The Welfare Economic Approach to Corporate Social Responsibility

Abstract

Welfare economic analysis of Corporate Social Responsibility (CSR) equates CSR with the provision of private goods bundled with provision of public goods (or, in the symmetrical case, bundled with the curtailment of public bads). Two common examples are cause-related marketing and “green goods” where private goods are sold at premiums that are then used to pay for provision of public goods and/or curtailment of public bads. This paper expands upon the model of Besley and Ghatak (2007 Besley, T. and Ghatak, M. 2007. “Retailing Public Goods: The Economics of Corporate Social Responsibility,”. Journal of Public Economics, 91(9): 1645–1663. [Crossref], [Web of Science ®] , [Google Scholar]) for the case of imperfect government to develop a complete typology for analyzing whether the provision/curtailment of public goods/bads will be best served by companies (through CSR), by imperfect governments or by non-profit organizations. Finally the paper discusses the main differences between the welfare economic approach to CSR and the general multi-disciplinary CSR literature.