Economic burden of comorbid chronic kidney disease and diabetes

Objective: To estimate real-world healthcare utilization and expenditures across the spectrum of chronic kidney disease (CKD), as determined by estimated glomerular filtration rate (eGFR) categories in patients with diabetes.

Methods: This study employed a retrospective cohort study design using the Truven Healthcare and Claims Dataset from 2009–2012. Index date was defined as the first eGFR value during a continuous enrollment period of 24 months. Cohorts of patients were stratified by Kidney Disease: Improving Global Outcomes CKD stage based on eGFR (stages 1: ≥90?mL/min/1.73?m²; 2: 60–89; 3A: 45–59; 3B: 30–44; 4: 15–29; 5: <15). Healthcare expenditures (total patient and payer paid claims) and utilization (number of claims or visits) were estimated 12-months post-index date using generalized linear modeling and negative binomial modeling, respectively, after adjusting for baseline characteristics.

Results: Of 130,098 patients with an index eGFR value and 24-months continuous enrolment, 64,521 (49.59%) were in stage 1 CKD, 47,816 (36.75%) were in stage 2, 13,377 (10.28%) were in stage 3A, 3,217 (2.47%) were in stage 3B, 898 (0.69%) were in stage 4, and 269 (0.21%) were in stage 5. Patients in stages 3A, 3B, and 4 CKD had 1.32 (95% CI?=?1.22–1.43), 1.59 (95% CI?=?1.41–1.80), and 2.65 (95% CI?=?2.23–3.14) times higher rates of diabetes-associated inpatient visits, respectively, compared with stage 1 CKD patients. Patients in stages 3A, 3B, and 4 CKD had increased incremental total annual healthcare expenditures of $1,732 (95% CI?=?$1,109–$2,356), $2,632 (95% CI?=?$1,647–$3,619), and $6,949 (95% CI?=?$5,466–$8,432), respectively, compared with stage 1 CKD patients.

Limitations: The claims data were generated for billing and reimbursement, not for research purposes.

Conclusions: These real-world data suggest an incremental and significant increase in economic burden in diabetes as kidney function declines, starting with moderate (stage 3A) CKD.     

Extraneous Alternatives And Strategy-Proofness

It is well known that the Gibbard–Satterthwaite theorem cannot be circumvented by adding extraneous alternatives that are included in the individual preference information but are never selected. We generalize this by proving that, for any domain on which every strategy-proof rule is dictatorial, the addition of extraneous alternatives will not permit the construction of a non-dictatorial and strategy-proof rule if the new domain is a product set. We show how this result, and our other theorem, can be applied to seven families of social choice situations, including those in which more than one alternative is selected.     

How low spending control harms consumers

Self-control is a critical aspect of consumer behavior that has wide-ranging implications for individual and societal welfare. The present research builds upon previous work regarding consumer spending self-control by examining the financial, decision making, social, and psychological consequences of low consumer spending self-control. Further, the relationship between consumer spending self-control and general self-control is explored, contributing to a greater understanding of how more general traits translate into spending-related outcomes. This research includes investigations of allocations to retirement accounts, responses to credit limits, resource depletion effects from repeated decision making, and the potential for broader negative social and psychological consequences from low consumer spending self-control.     

Joint estimation of discount rates and willingness to pay for public goods

We analyze willingness to pay (WTP) for environmental programs whose time periods of benefit and repayment differ, using a net present value framework that identifies parameters of both WTP and personal discount rates. Respondents to a contingent valuation survey focusing on protection of critical habitat buffer zones for the endangered Steller Sea Lion in Alaska were asked their willingness to pay for 1-, 5-, and 15-year repayment periods. We jointly estimate the personal discount rates and WTP via maximum likelihood, and compare with a model assuming a fixed, market discount rate.     

Perspectives on the measurement of job attitudes: the long view

Insights from 50 years of industrial research and consulting projects were synthesized into a set of themes pertaining to the measurement of job attitudes. The themes include the importance of developing instruments using vocabulary and style familiar to respondents; of programmatic research in developing and validating measures; of paying attention to anomalies and discontinuities in data; and of integrating research results into science and practice. The authors develop recommendations concerning obtaining useful field experience and fostering a scientific environment that respects and encourages efforts to improve psychological measurement.     

Accruals and the naïve out-of-sample prediction of operating cash flow

Recent evidence indicates that a naïve no-change out-of-sample forecast of operating cash flow is as accurate as regression model forecasts. The current study uses this evidence to compare the accuracy of two naïve cash flow forecasts: 1) a pure no-change forecast and 2) a no-change forecast which includes adjustments for changes in accounts receivable, inventory and accounts payable. The size- and accrual-matched results indicate that the naïve cash flow forecast with accruals is notably more accurate than the naïve forecast without accruals. Moreover, the results indicate that large sums of positive accruals are more useful for cash flow prediction than large sums of negative accruals. Overall, the study provides creditors, analysts and other members of the financial community with an efficient and effective protocol for cash flow prediction.     

Health insurers' use of quality improvement expenses to achieve a minimum medical loss ratio requirement

Health insurer medical loss ratios (MLRs) are the percentage of premium dollar spent on medical claims and healthcare quality improvement expenses (QIEs). QIEs include activities to improve patient health outcomes and safety, reduce medical errors, and prevent hospital readmissions. The Affordable Care Act mandates minimum MLRs in certain health insurance markets lest rebates be paid to policyholders. QIEs are reported in all markets regardless of whether that market is subject to minimum MLR requirements. Using health insurer statutory filings for a sample of group market insurers from 2010 to 2018, we employ a mixed regression discontinuity/regression kink approach to evaluate whether QIEs are used by insurers as a potential strategy for meeting the minimum MLR requirement. We show that health insurers' QIE increase in the loss ratio until meeting the minimum MLR requirement, have a significant discontinuous jump at the threshold, and decrease above the threshold after the introduction of the MLR mandate.     

Summary annual reports: length,readability and content

This paper examines summary annual reports (SAR) as an alternative channel for communicating financial information. We use a sample of New Zealand local governments (councils) that are required to report audited SAR. Using various measures, we compare document length and readability of SAR and annual reports (AR). We find that SAR are approximately 10 percent of the AR length and both have a ___very difficult___ readability score. We then use a disclosure index to examine the relation between SAR report length and the level of disclosures. After controlling for other factors that impact the level of disclosure, we conclude that the reduction in SAR is driven by lower levels of content. We then discuss the policy implications of our findings.     

UNDERPRICING OF IPOS THAT FOLLOW PRIVATE PLACEMENT

In this study we examine the underpricing of initial public offerings (IPOs) by firms that have private placements of equity before their IPOs (PP IPO firms). We find that PP IPOs are associated with significantly less underpricing than their peers. Furthermore, PP IPOs are associated with lower underwriting spreads, more reputable underwriting syndicates, and greater postissue analyst coverage as compared to IPOs that are issued by their industry peers under similar market conditions. Consistent with the implications of the information asymmetry explanation for IPO underpricing, our findings suggest that companies could benefit by conveying their quality via successful pre‐IPO private placements that help reduce the cost of going public.