Forecasting demands for inpatient services in a large public health care delivery system

This paper studies the use of autoregressive integrated moving average (ARIMA) time-series models for forecasting demands for inpatient services in a large public health care delivery system. Here, demands are measured in terms of monthly admissions and patient days by services and forecasts are made yearly. This paper emphasizes the implementation aspect of ARIMA models when they are used on a large scale basis in an institutional setting, and compares forecasts with actuals. For forecasting patient days, the adequacy of an indirect approach using the formula L = λW is also evaluated. Finally, we briefly describe how the forecasts are used in the context of resource allocation.     

Cost-effectiveness of rivaroxaban versus warfarin for stroke prevention in non-valvular atrial fibrillation in the Japanese healthcare setting

Abstract

Aims: This article aimed to examine the cost-effectiveness of rivaroxaban in comparison to warfarin for stroke prevention in Japanese patients with non-valvular atrial fibrillation (NVAF), from a public healthcare payer’s perspective.

Materials and methods: Baseline event risks were obtained from the J-ROCKET AF trial and the treatment effect data were taken from a network meta-analysis. The other model inputs were extracted from the literature and official Japanese sources. The outcomes included the number of ischaemic strokes, myocardial infarctions, systemic embolisms and bleedings avoided, life-years, quality-adjusted life-years (QALYs), incremental costs and incremental cost-effectiveness ratio (ICER). The scenario analysis considered treatment effect data from the same network meta-analysis.

Results: In comparison with warfarin, rivaroxaban was estimated to avoid 0.284 ischaemic strokes per patient, to increase the number of QALYs by 0.535 per patient and to decrease the total costs by ¥118,892 (€1,011.11) per patient (1 JPY = 0.00850638 EUR; XE.com, 7 October 2019). Consequently, rivaroxaban treatment was found to be dominant compared to warfarin. In the scenario analysis, the ICER of rivaroxaban versus warfarin was ¥2,873,499 (€24,446.42) per QALY.

Limitations: The various sources of data used resulted in the heterogeneity of the cost-effectiveness analysis results. Although, rivaroxaban was cost-effective in the majority of cases.

Conclusion: Rivaroxaban is cost-effective against warfarin for stroke prevention in Japanese patients with NVAF, giving the payer WTP of 5,000,000 JPY.     

Organizational Restructuring: Impact on Trust and Work Satisfaction

After the Asian financial crisis, companies are now contending with the current global economic slowdown. Whether it is at the national, industry or organizational levels, restructuring has gained currency as a strategic decision to realign internal structure with changing macro environmental factors. Faced with more competitive markets and greater demands on costs controls, organizations and businesses are taking the fast track to cost-cutting by downsizing, reorganizing their divisions, streamlining their operations, and closing down unprofitable divisions.Changes that are introduced in an organizational restructuring will affect the socio-psychological well-being of organization members given the potential for uncertainty that may accompany such changes. There is a need to better understand the consequences of organizational restructuring and consider some of its potential side effects on the work environment. Employees in a post-restructuring context are understandably wary about the future direction of the organization and their roles within it.This study is an attempt to examine the social-psychological impact of organizational restructuring on trust and work satisfaction. Additionally the inter-relationships between trust and work satisfaction, including their antecedents in the work environment are examined.Trust and work satisfaction levels were tracked before and three months after organizational restructuring for varying types of changes that were initiated during the restructuring. Both trust and satisfaction with working in the organization declined significantly when compared to pre-restructuring levels. Independent t-tests analysis indicated that there was a significant decline in trust for the work group which had a newly hired manager and a change in work processes. Results showed that there was a negative relationship between both work satisfaction and trust with the extent of change required of employees.The findings also showed that there was a positive relationship between trust and work satisfaction and that trust contributed to work satisfaction. Perception of colleagues willingness to help solve job-related problems contributed significantly to strengthening of trust relations among colleagues. Additionally, colleagues and supervisors willingness to listen to employee problems contributed significantly to work satisfaction.Results of the study highlighted the need for strategic decision-makers to consider the social impact of organizational restructuring. Top managers must realize that both trust and work satisfaction are important ingredients for the effective functioning of an organization and to actively ensure that support systems or structures are adequate and available to mitigate the negative impact, particularly if the changes to be implemented are extensive.     

Express Yourself: Why Managers' Disclosure Tone Varies Across Time and What Investors Learn from It

We argue that volatility in a manager's disclosure tone across time should be a function of two components: (i) the firm's innate operating risk and (ii) the extent to which the manager's disclosure transparently reflects that risk. Consistent with this argument, we find that both operating risk and disclosure transparency are important determinants of disclosure tone volatility. We then examine whether investors incorporate the incremental information provided by disclosure tone volatility into their assessments of firm risk. If disclosure tone volatility primarily provides investors with incremental information about a firm's operating risk, we should find a positive association between tone volatility and market-based assessments of risk. On the other hand, if disclosure tone volatility primarily provides investors with incremental information about a manager's disclosure transparency, we should find a negative association between tone volatility and market-based assessments of risk. Consistent with an operating risk explanation, we find a positive association between disclosure tone volatility and market-based assessments of firm risk after controlling for a comprehensive set of proxies for operating risk and transparency. We find little support for an information risk explanation, even when we examine multiple measures specifically designed to capture information risk. Taken together, our results suggest that although disclosure tone volatility is a function of both a firm's operating risk and a manager's disclosure transparency, investors appear to respond as if disclosure tone volatility only provides incremental information about a firm's operating risk.     

Revealed Preference Measures of Quality of Life in Australia's Urban and Regional Areas

Using data from the 2011 Census, we estimate quality of life across Australia. With mobile households, utility will be equalised across regions, so those regions with high real incomes must have a compensating low quality of life and vice versa. There are significant differences in quality of life across the 56 regions we examine. The top‐ranked region in our study is the Eastern Suburbs of Sydney, while the Western Australian Outback has the lowest quality of life. The drivers of quality of life are explored, and climate appears to be important as well as certain human‐made cultural amenities.     

A hybrid selection model for emerging technology

Technology selection, which influences the advantages of an enterprise or a country, is a multi-criteria decision issue that can be improved by integrating different methods. In addition, it is more and more difficult to identify the right technologies because the technologies are increasing in number and complexity. This study proposes a technology selection process integrating fuzzy Delphi method, analytic hierarchy process (AHP), and patent co-citation approach (PCA) for technology selection. The former effectively gathers experts' judgments toward technology selection criteria and conducts the fuzziness existing in their responses. The analytic hierarchy process has the strength of identifying criteria and obtaining their relationship and their weights. The patent co-citation approach identifies the major R&D fields of a specific technology from patent data. Through this proposed process, the key technology fields can be identified in the end. The organic light emitting diode (OLED) technology in Taiwan is used to be an example to illustrate the proposed technology selection process.     

Towards a brain-to-society systems model of individual choice

Canonical models of rational choice fail to account for many forms of motivated adaptive behaviors, specifically in domains such as food selections. To describe behavior in such emotion- and reward-laden scenarios, researchers have proposed dual-process models that posit competition between a slower, analytic faculty and a fast, impulsive, emotional faculty. In this paper, we examine the assumptions and limitations of these approaches to modeling motivated choice. We argue that models of this form, though intuitively attractive, are biologically implausible. We describe an approach to motivated choice based on sequential sampling process models that can form a solid theoretical bridge between what is known about brain function and environmental influences upon choice. We further suggest that the complex and dynamic relationships between biology, behavior, and environment affecting choice at the individual level must inform aggregate models of consumer choice. Models using agent-based complex systems may further provide a principled way to relate individual and aggregate consumer choices to the aggregate choices made by businesses and social institutions. We coin the term “brain-to-society systems” choice model for this broad integrative approach.     

The Effect of Taxes on the Location of Property-Casualty Insurance Firms

States levy insurance premium taxes, which are essentially gross receipt taxes on premiums. An unusual characteristic of insurance premium taxes is that in each state in which an insurance company writes premiums, the firm pays the higher of the tax rate in the state in which the company is domiciled and the state in which the policy is written. Thus, the choice of location has a significant effect on the firm's tax liability. Using firm-level data for the property-casualty (P-C) insurance industry, we calculate the firm-specific tax rate for each P-C firm for every possible state of domicile. We estimate conditional logistic models to analyze the effect of insurance premium taxes on the choice of the state of domicile of existing and relocated firms. We find robust evidence of a small, negative, and statistically significant effect of these taxes on the choice of the state of domicile.