Differential mortality and social security

Abstract This paper studies the normative problem of redistribution between individuals who differ in their lifespans. We discuss aspects related to the objective function and argue that aversion to multiperiod inequality should be taken into account. Then, we study the properties of the social optimum both with full information and with asymmetric information. We highlight the role of aversion to multiperiod inequality and show that it has substantial consequences on the design of Social Security schemes. In particular, we show that for a low (resp. high) aversion to multiperiod inequality, a negative (resp. positive) implicit tax rate on continued activity is desirable.     

"Quicker and sicker" under Medicare's prospective payment system for hospitals: new evidence on an old issue from a national longitudinal survey

Medicare's prospective payment system for hospitals (PPS), introduced in the USA in 1983, replaced cost reimbursement with a system of fixed rates which created incentives for hospitals to control costs. Previous studies found that elderly patients were discharged from hospital "quicker and sicker" under PPS and concluded that families were coping at home. We analyse a national longitudinal survey, the first National Health and Nutrition Examination Survey and its Epidemiologic Followup Study, which includes data on more outcomes over a longer period than earlier studies. We find that the rate of admission to nursing homes from the community in the first weeks after a hospital discharge more than tripled under PPS, suggesting that families were not always able to cope. As another response to sicker patients, discharges directly to nursing homes from hospitals, which jumped initially under PPS, may have risen further when payment rates were tightened in the early 1990s. Hospital readmissions fell after the first few years. Our findings are strengthened by the fact that we control for patients' health using health information collected independently of hospital admission.     

A review and validation of overall survival extrapolation in health technology assessments of cancer immunotherapy by the National Institute for Health and Care Excellence: how did the initial best estimate compare to trial data subsequently made available?

Background: Validation of overall survival (OS) extrapolations of immune-checkpoint inhibitors (ICIs) during the National Institute for Health and Care Excellence (NICE) Single Technology Assessment (STA) process is limited due to data still maturing at the time of submission. Inaccurate extrapolation may lead to inappropriate decision-making. The availability of more mature trial data facilitates a retrospective analysis of the plausibility and validity of initial extrapolations. This study compares these extrapolations to subsequently available longer-term data.

Methods: A systematic search of completed NICE appraisals of ICIs from March 2000 to December 2017 was performed. A targeted search was also undertaken to procure published OS data from the pivotal clinical trials for each identified STA made available post-submission to NICE. Initial Kaplan-Meier curves and associated extrapolations from NICE documentation were extracted to compare the accuracy of OS projections versus the most mature data.

Results: The review identified 11 STAs, of which 10 provided OS data upon submission to NICE. The extrapolations undertaken considered parametric or piecewise survival models. Additional data cut-offs provided a mean of 18 months of OS beyond the end of the original data. Initial extrapolations typically under-estimated OS from the most mature data cut-off by 0.4–2.7%, depending on the choice of assessment method and use of the manufacturer- or ERG-preferred extrapolation.

Conclusion: Long-term extrapolation of OS is required for NICE STAs based on initial immature OS data. The results of this study demonstrate that the initial OS extrapolations employed by manufacturers and ERGs generally predicted OS reasonably well when compared to more mature data (when available), although on average they appeared to underestimate OS. This review and validation shows that, while the choice of OS extrapolation is uncertain, the methods adopted are generally aligned with later-published follow-up data and appear appropriate for informing HTA decisions.     

Retaining the visitor,enhancing the experience: identifying attributes of choice in repeat museum visitation

• How people make choices in relation to cultural and leisure consumption has been explored from the viewpoint of motivation, lifestyle segmentation, and lifecycle. Little is known about the specific characteristics associated with choices to visit, re‐visit, or not to visit a museum. Understanding characteristics of choice, developing incentives, bundled packages, and levels of pricing is an essential element in marketing strategies for museums operating in a competitive leisure marketplace. However, determining what really matters to cultural consumers is complex and methodologies to assist in unraveling such complexities are not easily identified. This study aimed to address ways in which people respond to specific incentives as influences in choosing museum visitation. The study was conducted in two major museums in Australia to determine how useful choice modeling is in identifying features that matter to cultural consumers. The results suggest that choice modeling has much to offer in relation to understanding the benefits people are seeking from a museum experience as well as offering strategic insight into potential collaborative ventures and re‐combinations of existing museum products and services.

Copyright © 2008 John Wiley & Sons, Ltd.     

Diffusion of an Accounting Innovation: Fixed Asset Accounting in the NHS in Wales

As part of ‘New Public Management’ in the UK, changes have been made to the accounting regime. These changes typically involve the adoption of private sector accounting and budgeting approaches using accruals accounting. The process by which new ideas are spread is known as diffusion; this paper deals with the aspect of diffusion relating to the imposition of a new idea, accruals accounting, and how it is absorbed by the organisation, in this case the NHS in Wales. In particular, the paper questions whether the lack of secondary diffusion is limiting the influence of the new accounting approach. To analyse the level of diffusion we have focused on one aspect, namely, information on capital assets. The paper uses a mixture of qualitative and quantitative research methods including in-depth interviews with senior managers at two NHS Trusts and a questionnaire survey with responses from senior finance staff in all NHS Trusts in Wales. We conclude that the diffusion of accruals accounting for fixed assets has been restricted to the primary level at the top layer of management and has not penetrated below that level. There is evidence of continuing managerial indifference to the accruals accounting consequences of owning fixed assets.     

Nursing home choice,family bargaining,and optimal policy in a Hotelling economy

We develop a model of family bargaining to study the impact of the distribution of bargaining power within the family on the choice of nursing homes by families, and on the locations and prices chosen by nursing homes in a Hotelling economy. In the baseline (static) model, where the dependent parent cares only about the location of the nursing home, the markup of nursing homes is increasing in the bargaining power of the dependent parent, and nursing homes are located at the extreme periphery. We compare the laissez‐faire with the social optimum (which involves more central locations of nursing homes), and examine its decentralization in first‐best and second‐best settings. We explore the robustness of our results to introducing a bequest motive in a dynamic overlapping generations model, which allows us to study the joint dynamics of wealth accumulation and nursing home prices. If the bequest motive is strong, the markup is decreasing in the bargaining power of the dependent. However, wealth accumulation, by reducing interest rates, raises markup rates and nursing homes prices.     

The impact of a shift in organizational role on ethical perceptions: A comparative study

This study investigates ethical decision-making by considering the differences in ethical judgments between undergraduate business and MBA students on selected ethical issues facing employees and managers of today's businesses. The study further investigates differences in ethical judgments between undergraduates and MBAs in terms of a perceived position as an employee or as a manager. The findings indicate that undergraduate students tend to be more ethical than MBA students and that both groups tend to be more ethical when they perceive themselves as managers rather than employees. The authors discuss the implications for both business practitioners and educators.Shohreh A. Kaynama is Associate Professor of Marketing in the School of Business and Economics at Towson State University in Baltimore, Maryland. She earned a Ph.D. in Marketing and the Decision Sciences. Dr. Kaynama has published extensively in numerous National and International proceedings. Her area of research is strategic marketing, consumer behavior, applications of computers and decision sciences in marketing and global marketing. Louise W. Smith is Professor of Marketing in the School of Business and Economics at Towson State University in Baltimore, Maryland. Dr. Smith's main professional interest is consumer behavior. Dr. Smith's articles have appeared in the Journal of Public Policy & Marketing, Journal of Health Care Marketing, Journal of Marketing Education, Journal of Services Marketing, and Journal of Consumer Marketing among others. Algin B. King is Professor of Marketing in the School of Business and Economics at Towson State University in Baltimore, Maryland. He has served on the Faculties of seven universities, publishing numerous articles in National Professional Meetings Proceedings and scholarly journals including Journal of Euro-Marketing, Atlantic Economic Journal. In addition he has served as a business consultant to numerous business firms.