The hospital capital crisis: issues for trustees

The erosion of the capital position in the hospital industry--one of the most complex and overregulated industries in the United States--is a major challenge to trustees. Hospital trustees have often neglected to examine their hospitals' capital needs on more than a project-by-project basis. In dealing with their hospitals' capital needs, trustees, most of whom are successful business people, too often take off their "business" hats and put on their "social worker" hats. In doing so they not only neglect to subject their hospitals' capital and operating programs to searching cost-benefit review, but they also overlook much useful knowledge about how to use corporate organization to shelter new ventures and strengthen their hospitals' market position and solvency. In this article, the authors discuss how hospitals can adopt successful corporate restructurings and strategies to respond to the adverse financial developments they will have to face in the coming years.     

Ex Ante Research Evaluation and Regional Trade Flows: Maize in Kenya

Public sector investment in agricultural research is an important component of developing country efforts to bolster staple cereal production in the face of rapid population growth. This paper uses a spatial equilibrium model to evaluate the potential impact of maize research in six regions of Kenya. The application highlights the important role of research in meeting future food needs, as well as the geographic variability of producer and consumer benefits from technology and trade policy options. Despite significant research induced supply shifts, Kenya will require additional production increases of 1.5 to 2 per cent per year to meet stated goals of self-sufficiency in maize production with open markets. Import restrictions can ensure self-sufficiency and generate producer welfare gains at greater expense to the majority of Kenyans who are net consumers of maize. In the debate over trade policy, public sector investments in maize research should be seen as a potential mechanism to compensate producers for welfare losses associated with market liberalisation.     

Seeing One's Intellectual Roots: A review essay

The Review of Austrian Economics -     

Integrating Technology Traits and Producer Heterogeneity: A Mixed-Multinomial Model of Genetically Modified Corn Adoption

This article proposes a model of technology adoption that integrates demand for individual traits of new technologies with the potential for heterogeneity based on farm and farmer characteristics. The model is applied to recent genetically modified corn adoption data from Minnesota and Wisconsin farmers, using a mixed-multinomial logit (MMNL) model to estimate the effects of traits and farm and farmer characteristics on adoption outcomes. This approach allows explicit recovery of estimates of farmers' shadow prices for individual technology traits. Results show the importance of producer and regional heterogeneity in preferences for seed traits.     

Dual Job Holding and the Gig Economy: Allocation of Effort across Primary and Gig Jobs

This article explored motivations for allocating effort between “gig” and primary jobs using a sample of Amazon Mechanical Turk workers. We found that main job hour constraints, a commonly cited rationale for traditional moonlighting, were a motivation for men but not for women. Other factors affecting effort were also gender specific: Men were driven to spend more time on gig jobs to increase their incomes, while women were motivated by insecurity in their main job. Women, though not men, who were more depressed based on the Center for Epidemiologic Studies Depression scale earned less in their gig economy job. Finally, higher risk aversion reduced income from gig work for men, but not women. We concluded that motivations for effort allocated between the primary and gig jobs differ from those identified in past literature as important for traditional moonlighting decisions.     

To be or to refuse to be? Exploring the concept of leisure as resistance for young people who are visually impaired

This study explored the concept of leisure as resistance to social constraints of blindness. Leisure, because of its relative freedoms, has been conceptualised as a forum in which dominant cultural discourses and stereotypes can be challenged or resisted. A post-structural analysis of the leisure narratives of five young people who are blind revealed that they intentionally used aspects of leisure to resist some constraints and stereotypes of disability. Three strategies were identified: advocacy, redefinition and passing. Advocacy targeted other people’s beliefs; yet, some activities done to resist dominant discourses actually perpetuated them. Redefinition was a covert strategy to show themselves that they could be the same as everyone else. Passing was used in different ways. One young person used it when advocating, another to maintain social connections. However, maintaining social connections by passing was often at the cost of enjoyment, engagement and perceptions of ability. Empowerment through resistance in leisure related primarily to gains in self-confidence. These gains in self-confidence have the potential to contribute to social interactions and perhaps influence some of the discourses that operate as ‘truths’ about people who are blind.     

The Future Is Rural: Societal Adaptation to Energy Descent

Our present era of high-energy modernity will likely end over the course of the 21^st century, as fossil hydrocarbons wane and new energy technologies fail to compensate. Long-term trends of urbanization will reverse and a migration back to the countryside to regions of high biocapacity will ensue during the coming decades of energy descent. Food will become a central and organizing concern for de-industrializing populations, and key concepts and general methods to secure food supplies using less mechanization and with few outside inputs are presented. Given that high social complexity is institutionalized, with system identities locked-in, we should not expect a planned response to declining net energy. Instead, the so-called Great Simplification will unfold through a series of crises that force reorganization and alter belief systems. Resilience science suggests a role for promoting system transformability along more benign paths and into social forms that are more frugal.     

Burden of venous leg ulcers in the United States

Objective:

To estimate the annual incremental per-patient and overall payer burden (2012USD) of venous leg ulcers (VLU) in the US.

Methods:

Beneficiaries with and without VLU were identified using two de-identified insurance claims databases: aged 65+ from a 5% random sample of Medicare beneficiaries (2007–2010: n?～?2.3 million); and aged 18–64 from a privately-insured population (2007–2011: n?～?8.4 million). The index date was selected as the date of a VLU claim with no other VLU diagnoses in the preceding 12 months for the VLU cohort and as the date of a random medical claim for the non-VLU patients. These groups were matched using propensity scores to account for differences in demographics, comorbidities, resource utilization, and costs in the 12 month pre-index period. Medical resource use and costs incurred during the 12 month follow-up period were calculated for both payers. Drug costs and indirect work-loss due to disability and medically-related absenteeism were estimated for the privately-insured sample only. Annual VLU incidence rates were also estimated for both payers.

Results:

Data for 58,672 matched VLU/non-VLU pairs of Medicare and 22,476 matched pairs of privately-insured patients were analyzed. Relative to matched non-VLU patients, VLU patients used more medical resources and incurred annual incremental medical costs of $6391 in Medicare ($18,986 vs $12,595), and $7030 ($13,653 vs $6623) in private insurance ($7086 including drug costs). Compared with non-VLU patients, privately-insured VLU patients had more days missed from work (14.0 vs 10.0), resulting in 29% higher work-loss costs (comparisons significant at p?Limitations:

Findings did not account for out-of-pocket payments or other indirect costs (e.g., lost productivity), and relied on accuracy of diagnosis and procedure codes contained in claims data.

Conclusion:

These findings suggest an annual US payer burden of $14.9 billion.     

Risk,learning, and technology adoption

This article explores how decision makers learn and use information, with an application to the adoption of biotechnology in agriculture. The empirical analysis relies on experimental and survey data measuring risk preferences, learning processes, and the adoption of genetically modified (GM) seeds among U.S. grain farmers. While controlling for risk aversion, we link individual learning rules with the cognitive abilities of each decision maker and their actual GM adoption decisions. We find evidence that very few individuals are Bayesian learners, and that the population of farmers is quite heterogeneous in terms of learning rules. This suggests that Bayesian learning (as commonly assumed in the analysis of agricultural technology adoption) is not an appropriate characterization. In addition, we do not find a strong relationship between observed learning styles and the timing of GM seed adoption. To the extent that learning is a key part of the process of technology adoption, this suggests the presence of much unobserved heterogeneity in learning among farmers.