Benefit cost management in the new millennium

The new millennium will bring new challenges to managing employee benefit plans. Costs are going up. The provider community is consolidating. The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) and the Health Insurance Portability and Accountability Act of 1996 (HIPAA) have added cost and complexity to benefit plans. Employers expect strategic partnering and a high degree of flexibility while simultaneously reducing benefit managers' budgets and staff. This article provides specific strategies and tactics for managing benefit costs in this new era.     

Does multinationality matter? Implications of operational hedging for the exchange risk exposure

An important issue in global corporate risk management is whether the multinationality of a firm matters in terms of its effect on exchange risk exposure. In this paper, we examine the exchange risk exposure of US firms during 1983–2006, comparing multinational and non-multinational firms and focusing on the role of operational hedging. Since MNCs and non-multinationals differ in size and other characteristics, we construct matched samples of MNCs and non-multinationals based on the propensity score method. We find that the multinationality in fact matters for a firm’s exchange exposure but not in the way usually presumed – the exchange risk exposures are actually smaller and less significant for MNCs than non-multinationals. The results are robust with respect to different samples and model specifications. There is evidence that operational hedging decreases a firm’s exchange risk exposure and increases its stock returns. The effective deployment of operational risk management strategies provides one reason why MNCs may have insignificant exchange risk exposure estimates.     

The association between the severity of chronic kidney disease and medical costs among patients with type 2 diabetes

Aims: Examine healthcare costs across chronic kidney disease (CKD) stages for US patients with type 2 diabetes (T2D).

Materials and methods: IQVIA Real World Data Adjudicated Claims linked electronic medical records and insurance claims from January 1, 2012 through March 31, 2017 were used for this retrospective study. Adults diagnosed with T2D and comorbid CKD were included. General linear models incorporating splines were constructed, and information from these regressions were used to inform the relationship between medical costs and CKD. Multivariable analyses controlled for patient characteristics, vital signs, general health, prior medication use, prior visit to specialists, index A1c, and year of index date.

Results: There were 6,645 individuals who met the study criteria. Results generally indicate sharp increases in annual total medical costs and non-drug medical costs in the 1?year post-period for patients with Stage 4 or 5 CKD (estimated glomerular filtration rate [eGFR]?≤?30?mL/min/1.73 m²) with each 1 point reduction in eGFR from 30 associated with an increase of $1,870 in all-cause total medical costs (p?<?0.0001) and $1,805 of all-cause non-drug medical costs (p?<?0.0001). Similarly, each point decline below 30?mL/min was associated annual cost increases of $1,701 for CKD-related total medical costs, $1,695 for CKD-related non-drug medical costs, $173 for diabetes-related medical costs, and $187 for diabetes-related non-drug medical costs (all p?<?0.0001).

Limitations: The investigation included only patients with medical insurance and laboratory test results, and results may not be generalizable to all T2D patients with CKD. The methodology allowed us to determine associations, not causation, and potential confounders, such as duration of diabetes, diet, exercise, or social support, could not be assessed.

Conclusions: Results indicate there are sharp and significant increases in medical costs among T2D patients with Stage 4 and 5 CKD compared to those with earlier stages of CKD.     

Intrametropolitan migration: A simultaneous model of employment and residential location of white and black households

This study explores the relationship between the home and job location of the household within a metropolitan area. The model is an extension of the Alonso-Muth framework and allows the household to simultaneously choose its residential and employment location, monthly rent, number of rooms and the type of structure of the dwelling unit, so as to maximize its utility subject to the budget constraint.The data base is the Home Interview Survey conducted in 1965 by the (San Francisco) Bay Area Transportation Study Commission. The coefficients in the simultaneous model are estimated by two-stage least squares. The cross-section sample is stratified by tenure into renters and homeowners; by race into black and white households; and further by position in the life-cycle.The results of the location equations reveal that both the home and job location are responsive to each other which implies that the decentralization of jobs will result in the decentralization of residences for black households. The results of the housing equations imply that black and white households have almost identical elasticity of demand for housing. There is very slight evidence of price discrimination against black households. However, there is evidence that black households do face a geographical segregated market for rental housing.The results of this study argue that the decentralization of population is not due solely to rising incomes and will continue as long as industry decentralizes. Furthermore, governmental policies of increasing the income of central city residents, through subsidies to employers to locate in the central city will have a strong effect: inducing those residents to remain in or move into the central city. Thus, a policy that is meant to alleviate the plight of the city center may only result in strengthening the racial and income split between the suburb and the central city inhabitants.     

Poor Kids: A Report on Children in Poverty

Media coverage of income inequality and the economic plight of the middle class fails to analyze the long-term effects of growing inequality and to consider possible solutions. The article examines the literature on media coverage of income inequality and the middle class, and then examines how three competing models, the neoclassical economic model, the propaganda model, and the institutionalist model, explain the inadequate coverage of the effects and solutions.     

On a rank-order test for the equality of probability of an event

Abstract

The following situation is considered. A fixed number (= n) or sequence of independent trials T ₁ T ₂,…, T _n is given, and in each of these an event E mayor may not occur, It is further observed that the event E occurs a total of k times amongst the n trials T _i , (i = l,…, n). It is then required to test the hypothesis H ₀ that the probability of the occurrence of E is constant from trial to trial, i.e. H ₀ is the hypothesis: p ₁ = p ₂ = ? = p _n = p, if p _n (i = 1, …, n) represents the probability that E occurs on the ith trial.     

Men and women as managers: A significant case of no significant difference

What does it all mean? We've reviewed five studies involving almost 2,000 people compared on a total of 43 scales. We've studied matched pairs and controlled for level of managerial achievement. And after all is said and done, we have detected a total of two overall differences between male and female managers. One of these, involving managerial work motivation, favors females: Their work motivation profiles are more “achieving” than those of their male counter-parts. The other difference, pertaining to interpersonal competence, favors the male managers: They are more open and candid with their colleagues than are females. Add to these the more titillating than significant anomalies of differing back-up style preferences and we are left with one conclusion: Women, in general, do not differ from men, in general, in the ways in which they administer the management process.Managers themselves and their subordinates concur. It seems that the disproportionately low numbers of women in management can no longer be explained away by the contention that women practice a different brand of management from that practiced by men. Whereas this may amount to good news in some quarters, we ought not be prematurely elated by discovering that women manage just the way men do. Carolyn Sherif has pointedly called attention to the fact that all is not necessarily well in today's male-oriented management activities.We of course view management in its more global aspects: The important issue to us is how an individual manages in relation to achievement criteria. Individual achievement and organizational health ultimately depend on the way management is practiced. And we now see that the way management is practiced is not related to the sex of the manager — the issue is generic rather than gender-bound.     

Do analysts who understand accounting conservatism exhibit better forecasting performance?

This study investigates the performance of analysts when they match the asymmetric timeliness of their earnings forecast revisions (i.e., asymmetric forecast timeliness) with the asymmetric timeliness of firms’ reported earnings (i.e., asymmetric earnings timeliness). We find that better timeliness‐matching analysts produce more accurate earnings forecasts and elicit stronger market reactions to their forecast revisions. Further, better timeliness‐matching analysts issue less biased earnings forecasts, more profitable stock recommendations and have more favorable career outcomes. Overall, our results indicate that analysts’ ability to incorporate conditional conservatism into their earnings forecasts is an important reflection of analyst expertise and professional success.     

Evaluation of medical costs associated with use of new oral anticoagulants compared with standard therapy among venous thromboembolism patients

Objective:

This study evaluated differences in medical costs associated with clinical end-points from randomized clinical trials that compared the new oral anticoagulants (NOACs), dabigatran, rivaroxaban, apixaban, and edoxaban, to standard therapy for treatment of patients with venous thromboembolism (VTE).

Research design and methods:

Event rates of efficacy and safety end-points from the clinical trials (RE-COVER, RE-COVER II, EINSTEIN-Pooled, AMPLIFY, Hokusai-VTE trial) were obtained from published literature. Incremental annual medical costs among patients with clinical events from a US payer perspective were obtained from the literature or healthcare claims databases and inflation adjusted to 2013 costs. Differences in total medical costs associated with clinical end-points for the NOACs vs standard therapy were then estimated. One-way and Monte Carlo sensitivity analyses were carried out.

Results:

A lower rate of major bleedings was associated with use of any of the NOACs vs standard therapy. Except for dabigatran, use of NOACs was also associated with a lower rate of recurrent VTE/death. As a result of the reduction in clinical event rates, the overall medical cost differences were ?$146, ?$482, ?$918, and ?$344 for VTE patients treated with dabigatran, rivaroxaban, apixaban, and edoxaban, respectively, vs patients treated with standard therapy.

Conclusions:

When any of the four NOACs are used instead of standard therapy for acute VTE, treatment medical costs are reduced. Apixaban is associated with the greatest reduction in medical costs, which is driven by medical cost reductions associated with both efficacy and safety end-points. Further evaluation may be needed to validate these results in the real-world setting.     

AIDing contraception: HIV and recent trends in abortion

Using a difference-in-differences estimation framework and state-level data, we investigate the potential role of HIV/AIDS in contributing to declining abortion utilization in the United States. Our results suggest that the perceived risk of HIV contraction negatively affected unwanted pregnancies. Specifically, a 10% increase in HIV incidence is associated with 0.34–1.1% fewer abortions per live births, an effect that can account for at least one-tenth of the sharp decline in abortions observed from the early 1980s to mid-1990s.