Subjects’ decision-making process: an empirical analysis on patients’ mobility process and the role of pharmaceutical clinical research

This paper proposes a decision-making process based on trust. Imagining the relationship between patients and physicians, based on the trust that the former put in the latter, which is the effect of experimental activities on the researcher’s (and/or medical center’s) reputation? Is it admissible to suppose a positive correlation between pharmaceutical clinical research and the return in terms of image for the medical care suppliers? This is the research question of this paper. Through empirical analysis, this work supports the proposed decision-making process and tries to answer this open issue. Considering Italy between 2002 and 2006, the analysis concerns the patients’ mobility process among regions and how pharmaceutical research can affect patients’ perception of the quality of medical treatments. Results suggest that mobility is clearly affected by a decision-making process based both on already existing good reputation (i.e., cognitive) and on confirmation of that image (i.e., behavioral). The latter is the phase in which the physician’s effort in the informed consent session of an experimental activity might make the difference in the reputation of the health care suppliers and, therefore, be a key factor in hospitalization choice.     

Special issue on forecasting,use of survey data on expectations,and panel data applications: editors’ introduction

This study reinvestigates the relationship between unemployment and crime, but is the first to focus explicitly on the effects of long-term unemployment on crime. A unique finding is that long-term unemployment shows a strong association with violent crime, an effect which is greater than that of total unemployment on property crime in this and most previous studies. Long-term unemployment thus identifies a marginal group for committing crime (particularly violent crime) better than total unemployment, with the duration of unemployment plausibly increasing the strain that fosters violent behaviour.     

Assessment of the effect of the financial crisis on agents’ expectations through symbolic regression

Agents’ perceptions on the state of the economy can be affected during economic crises. Tendency surveys are the main source of agents’ expectations. The main objective of this study is to assess the impact of the 2008 financial crisis on agents’ expectations. With this aim, we evaluate the capacity of survey-based expectations to anticipate economic growth in the United States, Japan, Germany and the United Kingdom. We propose a symbolic regression (SR) via genetic programming approach to derive mathematical functional forms that link survey-based expectations to GDP growth. By combining the main SR-generated indicators, we generate estimates of the evolution of GDP. Finally, we analyse the effect of the crisis on the formation of expectations, and we find an improvement in the capacity of agents’ expectations to anticipate economic growth after the crisis in all countries except Germany.     

Putting a price tag on others’ perceptions of us

Standard economic theories assume that people are self-interested and their wellbeing solely dependent on their own material gains or losses. Unless they have an impact on monetary payoffs, the perceptions of anonymous individuals are irrelevant to people’s decision making. However, a large body of research in sociology and social psychology demonstrates that self-identity is developed through one’s understanding of how one is perceived by others. Using (Cooley’s, Human nature and the social order, 1964) concept of the “looking-glass self” as a framework, we evaluate experimentally whether or not people care about the imputed judgment of anonymous others arising from their imagination of their perceptions. We implemented variants of the Becker–DeGroot–Marschak mechanism to elicit the monetary value attached to the perceptions by participants. In one variant, only nonnegative bids were allowed, while in another, negative bids were allowed. We show that in an environment in which the perceptions of others are only conveyed to participants anonymously and privately, self-interested individuals exhibited strong negative perception avoidance even though the perceptions have no impact on their monetary payoff. The participants were willing to spend a significant amount in order to avoid confirming the supposedly negative perception. Thus, for them, ignorance was truly bliss. We also show that, in the absence of the audience effect, the fair-minded participants adopted a neutral attitude towards the perception of them as fair.     

Finance commission of India’s assessments: a political economy contention between expectations and outcomes

We explore the normative fiscal assessments of the Finance Commission (FC) of India, and realisation of fiscal policy with regard to Central Finances over the period 1990–2012. We employ the Theil’s inequality coefficient to investigate the magnitude of assessment errors and its partitioning in to bias, slope and random components. Furthermore, this article also evaluates the efficiency, biasedness and persistence of forecast errors. The robustness of the efficiency results are confirmed with the application of maximum entropy bootstrap. The objective of this study is to examine the structural basis on which FCs make their awards rather than examining the predictability of the forecasts. The story of FC’s assessments reflects an interesting political economy theatre of contention between aspirations and outcomes. Our key findings are as follows: First, source of errors for assessments of tax revenue, nontax revenue, interest payments, defence revenue expenditure, plan revenue expenditure and fiscal deficit is principally due to random component. However, the errors in the remaining economic parameters originate due to systematic components i.e. mean and slope errors. Second, the expenditure side predictability is lower than the revenue side predictability.     

Critical reflections on a realist interpretation of Friedman’s ‘Methodology of Positive Economics’

Uskali Mäki has offered an innovative scientific realist account of Milton Friedman’s 1953 essay, ‘The Methodology of Positive Economics’, which directly challenges the dominant instrumentalist interpretation. This paper offers critical reflections on Mäki’s approach and interpretation. It is argued that Mäki’s method of rereading-rewriting the text is problematic; that an unforced instrumentalist account of unrealistic assumptions can be extracted from the text itself; and that seemingly realist passages can be plausibly read as expressing an instrumentalist stance.     

Health services research in heart failure patients treated with a remote monitoring device in Germany—a retrospective database analysis in evaluating resource use

Abstract

Objectives:

Heart failure is an increasing burden for all healthcare systems with prevalence reaching over 20 million patients worldwide and direct costs of disease requiring ～1% of healthcare budget expenditures. Beyond traditional pharmaceutical treatment, medical devices and remote monitoring tools were introduced to ensure a closely managed control of patients. In this context, a decision-maker needs to know whether the new technology provides clinical benefit towards patients and what resource use is attached to them.

Methods:

Health services research is a complementary approach to clinical trials providing results to the impact of the technology in real life settings. As an example this study reports of a secondary data analysis of one of the largest health insurance companies in Germany, comparing resource use of heart failure patients receiving a cardiac resynchronization therapy (CRT) device coupled with a fluid status monitoring and alert function with patients receiving conventional CRT, ICD (implantable cardioverter defibrillator), or no intervention.

Results:

Disease-associated expenses can be attributed to far more than 50% to heart failure. Although implementation of the CRT device with alert function was most expensive (31,794 Euros compared to 27,659 Euros in the conventional CRT group, 24,128 Euros in the ICD group, and 3735 Euros in the no intervention group) in the first year after implementation, the least costs have been caused in this group (7000 Euros compared to more than 11,000 Euros in all other groups).

Conclusion:

This article highlights potential health services research approaches focusing on the example of a CRT device coupled with a pulmonary diagnostic and alert function. Although this retrospective analysis holds a number of limitations (e.g., small number of patients in intervention group, cost calculations only from the payer perspective), and despite the need for randomized controlled trials, it was shown that secondary data research in this field is a valuable approach.     

Ecological footprint analysis on the traditional rice-fish agricultural area： a case study of Qingtian County, Zhejiang Province, China

Qingtian County of Zhejiang Province, China has maintained the traditional rice-fish agriculture for about 2,000 years and formed exceptional cultural heritage based on this kind of production mode, so it was ed by FAO as a pilot site for the rice-fish agricultural heritage systems in 2005. This research has applied the indicators of ecological footprint and biocapacity to monitor the environmental conditions of Qingtian County, aiming to find the impact that the traditional agricultural production mode and the local inhabitants lifestyle have placed on the local environmental conditions as well as the role they have played in maintaining ecological balance, cultural inheritance and regional sustainable development. Results show that Qingtian County is characterized by a nearly breakeven total ecological balance, as opposed to Zhejiang Province, the world and other agricultural regions. However, compared with another rice-fish agricultural region, Congjiang County which enjoys a considerable ecological reserve, Qingtian County has consumed a greater amount of environmental resources. Specifically, about half of the ecological footprint of Qingtian County can be attributed to the cropland （50.8%） while the CO2 area only accounts for 11.2%, which is dramatically different from that of the modern industrialized regions. And a vast of percentage of energy is caused by the combustion of fuelwood which not only requires the land to absorb the CO2 emission it has generated but also occupies the forest where it has been chopped.     

Factor analysis and structural equation model for patent analysis: a case study of Apple’s technology

In this study, we analyse patent data for technology analysis (TA) because patents are rich in information on developed technology. The results of TA can be used to perform more efficient research and development (R&D) planning. Most companies are trying to develop new and innovative technologies to improve their competitive positions. Research involving TA has been introduced in a variety of fields. Most of the published research analysed original variables related to a target technology. However, it is necessary to analyse the latent variables as well as the original variables included in the technology to achieve a better TA model. Therefore, we propose a factor analysis and a structural equation model for patent analysis. In addition, we use Apple’s patents to determine the target technology. In our case study, we analyse Apple’s technologies by latent variables. Our case study shows how the proposed model is applied to Apple’s R&D planning.     

Impact of asset price fluctuation on China’s monetary policy: An empirical analysis based on quarterly data, 1994–2006

The strenuous fluctuation in global asset price in recent years has had a profound impact on the economic and social development of every country. An empirical analysis indicates that asset prices (the stock price index and real estate prices) are important endogenous variables affecting the interest rate reaction function of central bank monetary policy. With expected inflation as a given, each one percentage point rise in output gap will cause a 0.79 percentage point reduction in interest rates by the central bank and each one percentage point rise in real estate price will result in a 2.2 percentage point rise in interest rates. The stock price index does have an influence on the trends in monetary policy, but it is less salient than the impact of housing prices. We also show that monetary policy that employs asset price as an endogenous variable increases the central bank’s control in seeking to attain its objectives. Therefore we suggest that the central bank should make asset price fluctuation an endogenous variable and incorporate it into its forward-looking interest rate rule, in order to facilitate the healthy development of China’s markets for real estate, stocks and derivatives, energy and bulk commodities and maintain rapid, smooth, sustainable and harmonious economic development.     

The impact of terrorism on expectations,trust and happiness – the case of the November 13 attacks in Paris,France

I use quasi-experimental evidence to measure the impact of the 13 November 2015 attacks in Paris, France, on various channels through which terrorism can affect the economy. The evidence suggests the attacks reduced optimism and increased trust in the national government but did not affect current life satisfaction nor political orientation.     

The effect of a wife’s retirement on her husband’s mental health

This article examines the effect of wives’ retirement on their husband’s mental health in Australia. By exploiting the exogenous variations in women’s retirement induced by the age pension qualifying ages, we find that spousal retirement status has a positive impact on the mental health of older men. This beneficial impact is found to strengthen with wives’ time spent in retirement. We show that wife’s retirement affects the constituents of her husband’s mental well-being in different ways. We also have identified four channels for the positive linkage between older women’s retirement and the mental health of their spouse.     

Cost–consequence analysis of a hemostatic matrix alone or in combination for spine surgery patients

Background: A five-year retrospective database analysis comparing the use of Floseal¹ flowable topical hemostat alone (F) and in combination with gelatin/thrombin (F?+?G/T) to achieve hemostasis and control surgical bleeding showed higher resource utilization for F?+?G/T cases relative to F matched pairs during spinal surgery. Lower resource use in the F group was characterized by shorter hospital length of stay and surgical time as well as fewer blood transfusions and less hemostat agent used per surgery.

Objective: To evaluate the cost–consequence of using F compared to F?+?G/T in minor, major and severe spinal surgery from the US hospital perspective.

Methods: A cost–consequence model was developed using the US hospital perspective. Model inputs include clinical inputs from the literature, cost inputs (hemostatic matrices, blood product transfusion, hospital stay and operating room time) from the literature, and an analysis of annual spine surgery volume (minor, major and severe) using the 2012 National Inpatient Sample (NIS) database. Costs are reported in 2017?US dollars. One-way and probabilistic sensitivity analyses address sources of variability in the results.

Results: A medium-volume hospital (130 spine surgeries per year) using F versus F?+?G/T for spine surgeries is expected to require 85 less hours of surgical time, 58 fewer hospital days and 7 fewer blood transfusions in addition to hemostat volume savings (F: 1?mL, thrombin: 1994?mL). The cost savings associated with the hospital resources for a medium-volume hospital are expected to be $317,959 (surgical hours?=?$154,746, hospital days?=?$125,237, blood transfusions?=?$19,023, hemostatic agents?=?$18,953) or $2445 per spine surgery.

Conclusions: The use of F versus F?+?G/T could lead to annual cost savings for US hospitals performing a low to high volume of spinal surgeries per year.     

Predicting time to nursing home placement based on activities of daily living scores – a modelling analysis using data on Alzheimer's disease patients receiving rivastigmine or donepezil

Abstract

Objective: To quantify the impact of activities of daily living (ADL) scores on the risk of nursing home placement (NHP) in Alzheimer's disease (AD) patients.

Setting: Models predicting NHP for AD patients have depended on cognitive deterioration as the primary measure. However, there is increased recognition that both patient functioning and cognition are predictive of disease progression.

Methods: Using the database from a prospective, randomised, double-blind trial of rivastigmine and donepezil, two treatments indicated for AD, Cox regression models were constructed to predict the risk of NHP using age, gender, ADL and MMSE (Mini-Mental State Examination) scores as independent variables.

Participants: Patients aged 50–85 years, with MMSE scores of 10–20, and a diagnosis of dementia of the Alzheimer type.

Results: Cox regression analyses indicated that being female, older age, lower ADL score at baseline, and deterioration in ADL all significantly increased the risk of NHP. Over 2 years, risk of NHP increased by 3% for each 1-point deterioration in ADL score independent of cognition.

Conclusion: Data analyses from this long-term clinical trial established that daily functioning is an important predictor of time to NHP. Further research may be required to confirm whether this finding translates to the real world.     

The economic burden of advanced Parkinson’s disease: an analysis of a UK patient dataset

Abstract

Background:

To evaluate the cost burden of patients with advanced Parkinson’s disease (PD) according to the waking hours per day spent in OFF state. An analysis of resource use comprising medical services, professional care and informal care data from an observational, cross-sectional study was conducted.

Methods:

A total of 60 physicians comprising 40 neurologists and 20 geriatricians across the UK participating in the Adelphi PD Disease Specific Programme took part. There were 302 PD patients at H&Y stages 3–5. Patients were characterised according to the percentage of time per day spent in OFF state (<25%, 26–50%, 51–75%, >75%).

Results:

Average 12-monthly total costs increased according to the time spent in OFF state from £25,630 in patients spending less than 25% of their waking hours in OFF to £62,147 for patients spending more than 75% of their time in OFF. Overall, 7% of costs were attributed to direct medical care, while 93% were split between direct non-medical professional care (50%) and indirect informal care (43%).

Limitations:

Low patient numbers in the more advanced disease stages of PD led to very little or no data to directly inform some of the severe health states of the analysis. Data gaps were filled in with data derived from a regression analysis which may affect the robustness of the analysis.

Conclusion:

This study illustrates the increasing costs of advancing PD, in particular related to the time spent in OFF state, and identifies that the foremost cost burden is associated with the care needs of the patient rather than medical services.     

Is a little sunshine all we need? On the impact of sunshine regulation on profits,productivity and prices in the Dutch drinking water sector

This paper analyzes the performance of Dutch drinking water utilities before and after the introduction of sunshine regulation, which involves publication of the performance of utilities but no formal price regulation. By decomposing profit change into its economic drivers, our results suggest that, in the Dutch political and institutional context, sunshine regulation was effective in improving the productivity of publicly organised services. Nevertheless, while sunshine regulation did bring about a moderate reduction in water prices, sustained and substantial economic profits suggest that it may not have the potential to fully align output prices with economic costs in the long run. In methodological terms, the DEA based profit decomposition is extended to robust and conditional non-parametric efficiency measures, so as to account better for both uncertainty and differences in operating environment between utilities.     

Decentralized planning in a market economy? On the nature of Coase’s research program

By drawing attention to the planning islands of firm organizations in a market economy, Coase makes us believe that besides the price mechanism, there is another means of coordination, namely deliberate coordination. With the firm as an exemplary case of deliberate coordination was introduced into landscape of economics, Coase initiated a new research program which is to inquire into how efficiency is (and could be) achieved via various kinds of institutional arrangements, from the price mechanism, to firms, to government regulations. This paper acknowledges the positive role Coase has played in drawing economists’ attention to the generally neglected field of organizational research. It criticizes, however, his research program for viewing the economy, or society, from the perspective of some concrete decision-making entity.     

Impact of instrumental ties,tacit knowledge sharing and affective commitment on absorptive capacity – an empirical study of pharmaceutical companies

Absorptive capacity construct has gained importance since last two decades especially in knowledge intensive environment. The companies invest their time and resources to achieve strategic goals and thus enhance their absorptive capacity in order to deal with new knowledge requirements. Companies largely focus on the macro level processes and mechanisms which are external to their boundaries and ignore the intra company factors critical to absorptive capacity. This study explores the impact of human behaviours related to instrumental ties (INST), affective commitment (AFC) and tacit knowledge sharing (TKS) on absorptive capacity (ACAP). Results of this study based on sample from pharmaceutical companies of Pakistan show significant contribution of human behaviour in development of absorptive capacity. The employees’ behaviours may not be ignored by decision makers in pharmaceutical companies while formulating knowledge strategies.