The real-world economic impact of home-based video electroencephalography: the payer perspective

Abstract

Aims: Electroencephalography (EEG) is an established method to evaluate and manage epilepsy; video EEG (VEEG) has significantly improved its diagnostic value. This study compared healthcare costs and diagnostic-related outcomes associated with outpatient vs inpatient VEEG among patients with epilepsy in the US.

Materials and methods: This study used Truven MarketScan Commercial and Medicare Supplemental claims databases. Patients with a VEEG between July 1, 2013 and December 31, 2016 were identified. Index event was the first VEEG claim, which was used to determine inpatient and outpatient cohorts. Continuous health plan enrollment 6?months pre- and 12?months post-index VEEG was required. Primary outcomes were costs during the index event and 12?months post index. A generalized linear model with gamma distribution and a log link was used to estimate adjusted index and post-index costs.

Results: Controlling for baseline differences, epilepsy-related cost of index VEEG was significantly lower for the outpatient ($4,098) vs the inpatient cohort ($13,821; p?<?0.0001). The cost differences observed at index were maintained in the post-index period. The 12-month post-index epilepsy-related costs were lower in the outpatient cohort ($6,114 vs $12,733, p?<?0.0001). Time from physician referral to index VEEG was significantly shorter in the outpatient cohort (30.6 vs 42.5?days). Patients in the inpatient cohort were also more likely to undergo an additional subsequent follow-up inpatient VEEG (p?<?0.0001).

Limitations: Administrative claims data have limitations, including lack of data on clinical presentation, disease severity, and comprehensive health plan information. Generalizability may be limited to a US insured population of patients who met study criteria.

Conclusions: Index VEEG was less costly in an outpatient vs inpatient cohort, and costs were lower during the follow-up period of 12?months, suggesting that outpatient VEEG can be provided to appropriate patients as a less costly option. There were fewer follow-up tests in the outpatient cohort with similar pre- and post-index diagnoses.     

Corporate tax and location choice for multinational firms

This article examines the effects of corporate tax on these location decisions of newly established multinational subsidiaries across 26 European countries over an 8-year period. We contribute to the existing literature by examining the effects of a non-linear response of firm location decisions to changes in the tax rate. We also show that there are large variations in the sensitivity to tax rates across sectors and firm size groups. In particular, financial sector firms are more than twice as sensitive to changes in corporation tax rates relative to other sectors. Our baseline result is a finding that a 1% increase in the statutory or policy rate of corporation tax would lead to a reduction in the conditional location probability of 0.68%. Using the effective average tax rate, the marginal effect implies a reduction in the location probability of 1.15% following a 1% increase in the tax rate. Although overall tax has the expected negative effect on location probability, the marginal effect of an increase is lower at higher rates of tax.     

The Effect of Groupwork on Ethical Decision-Making of Accountancy Students

Recent accounting scandals involving the collapse of large corporate firms have brought into question the adequacy of ethics education within accounting programs. This paper investigates the ethical decisions of accountancy students and in particular analyses the effect of group (as opposed to individual) decision-making on ethical decisions. Final year accountancy students (sample size of 165) were randomly allocated into two experimental conditions. The participants were then presented with five (5) ethical vignettes. One experimental condition involved completing the ethical decisions as individuals (60). The other involved completing the ethical decision-making as a group of 3–4 participants (34). A consistent pattern of behaviour was observed in the analysis of individual versus group responses. Individuals displayed stronger tendencies than groups to take the extreme actions of acting either unethically or ethically (whistleblowing), whereas groups displayed stronger tendencies to take the safer (neutral) options. It was concluded that groups reached consensus decisions, in an ethical context, probably as a result of peer pressure. The significant implication of this finding is in relation to the emphasis accounting programs place on group work. Group work may enhance students’ abilities to work as a team. However, as revealed in this study’s results, group work may not be an effective means of producing the optimal decision in all subject matter areas, especially complex areas such as ethical decision-making.     

Community-based research: Engaging universities in technology-related knowledge exchanges

Many universities are disengaged from their local regions. While universities are hotbeds of knowledge with the potential to generate new and disruptive technologies, their development strategies and public relations engagements rarely emphasize the potential of universities to act as local and regional economic engines. Similarly, information systems (IS) and other scholars generally aim to make international, not local impacts. Local contributions are often viewed as distractions from more visible and highly rewarded roles in the global scholarly community, such as publishing in international journals. This Global Challenge article argues that universities' local ecosystems are appropriate targets for IS scholarly activity, particularly when this is undertaken in the form of community-based research (CBR). Following conceptual discussions of ‘community’ and key elements of CBR, we draw on the authors' personal research experiences to evaluate the potential contributions of IS scholars in terms of CBR projects focused on technology-related knowledge exchange. After outlining implications and potential future directions for IS researchers, we close by presenting a call to IS scholars to intensify their local ecosystem research collaborations in technology-related knowledge exchanges contexts, in order to increase the relevance and local impact of their research.     

The Importance of Understanding Student Learning Styles in Accounting Degree Programs

Improvements in the tertiary education of accounting students benefit the profession. Analysis of the interaction of learning styles and teaching methodologies in accounting degree programs revealed that when learning styles matched teaching methods used, usefulness was assessed as high. When they differed, usefulness deteriorated. To maximise educational benefit this interaction should be considered, but this has resource implications. Accounting education is critical and any improvements in the tertiary education of accounting students should result in better prepared graduates entering the profession. This study evaluates accounting students’ learning styles and the interaction of learning styles and teaching methodologies in degree programs. Nine classes of accounting students (648 students) spread across four years and two degree programs were evaluated. Students self‐evaluated their learning styles, pre‐instruction. They were then subject to two separate teaching techniques (one active and one passive) in each course. Learning styles were then re‐assessed and teaching techniques evaluated. Accounting students displayed a preference for passive learning, even those far advanced in their degrees. Furthermore, when learning styles matched teaching methods used, usefulness was assessed as high but when learning styles and teaching methods differed, usefulness deteriorated. Overall, active learners rather than passive learners deemed the teaching methods to be more effective. The implications are significant. To maximise educational benefit for the accounting profession, student learning styles should be assessed before designing appropriate teaching methodologies. This has resource implications, which would have to be considered.     

Willingness to pay for improving fatality risks and asthma symptoms: Values for children and adults of all ages

We examine effects of age on valuation of mortality and morbidity risks using a two-stage contingent valuation survey and a sample including parents of children aged 4–17 years and adults aged 18–92. The survey used a hypothetical improved asthma therapy to elicit (1) tradeoffs between asthma control and fatality risk, (2) willingness to pay (WTP) for reduced fatality risk, and (3) WTP for asthma control. The mean value of statistical life (VSL) at average age is $3.8M, but age affects VSL and nonlinearly. Estimated VSL is highest at age four ($14.1M), falls until age 30 ($3.7M), rises until age 66 ($6.7M), and then falls to $1.5M by age 92. Results from the wide age range considered may partly reconcile apparently conflicting results from previous studies focused on narrower age ranges. The value of asthma control is not as strongly related to age as VSL and ranges from $1700 to $4000 annually.     

The Negative Impact of Additional Legislation on Corporate Stewardship

Many jurisdictions worldwide have reacted to the global financial crisis by implementing new or improved corporate legislative requirements. These would impact upon company directors and audit committee members. This study examines the attitudes of Australian members of these two groups to nine United Kingdom proposed amendments to corporate legislation. Both groups were predominantly opposed to additional legislation (failing to see how it could improve current stewardship) and indicated they would be less comfortable in their current roles. The implications are significant. Additional legislation, although well intentioned, may have negative impacts on stewardship, as requirements may deter good corporate citizens from retaining or seeking office.     

Financial structure and diversification of European firms

Small and medium enterprises have been shown to rely mainly on banks for funding and, unlike larger firms, rarely have direct access to capital markets. This article looks at the extent to which SMEs avail of a wider range of funding options and how their use differs across firms and countries. Across all countries, we find that firms are currently using two or three sources of finance to fund their operations and have had previous experience of other types of funding. There are some noticeable differences across countries with peripheral economies generally being less diversified. Differences across firm size and age groups are more marked than cross-country variation, with smaller and younger firms significantly more reliant on a limited set of finance types and older, larger firms having more diversified financial structures. Looking at individual sources of financing, we find that trade credit and informal sources of finance are extremely prevalent across all countries, with Irish firms being particularly likely to use them as sources of funding.     

Pass‐Through and the Prediction of Merger Price Effects

We use Monte Carlo experiments to study how pass‐through can improve merger price predictions, focusing on the first order approximation (FOA) proposed in Jaffe and Weyl [ 2013 ]. FOA addresses the functional form misspecification that can exist in standard merger simulations. We find that the predictions of FOA are tightly distributed around the true price effects if pass‐through is precise, but that measurement error in pass‐through diminishes accuracy. As a comparison to FOA, we also study a methodology that uses pass‐through to select among functional forms for use in simulation. This alternative also increases accuracy relative to standard merger simulation and proves more robust to measurement error.     

Realized absorptive capacity and entrepreneurial universities’ organizational change: the role of process innovation practices

Although essential to all institutions, organizational change is a complex and high risk activity. In this paper, we examine how organizations develop and implement capabilities to facilitate organizational change. Drawing on the dynamic capability perspective and a ‘resourcing’ synergy view, we investigate how realized absorptive capacity in terms of transformation and exploitation capability directly affects organizational change, and how process innovation practices act as an effective mechanism that link transformation and exploitation capability with organizational change. To distinguish our analysis, we focus on both an emerging organizational form and an emerging economy context. Specifically, on the basis of a questionnaire survey of 316 academics from entrepreneurial universities in Malaysia, we find that both transformation and exploitation capability are facilitators of organizational change. However, the relationship of transformation capability with organizational change is fully mediated by process innovation practices, while the relationship between exploitation capability and organizational change is partially mediated by process innovation practices. Our research therefore contributes to the dynamic capability perspective of organizational change and absorptive capacity by highlighting the importance of integrating organizational transformation and exploitation capability with process innovation practices in different ways to facilitate organizational change. Our findings and accompanying discussion on how process innovation practices can generate moves towards universities that are more entrepreneurial will also be of interest to university managers and policy makers.