On the medical loss ratio (MLR) and sticky selling general and administrative costs: Evidence from health insurers

The Patient Protection and Affordable Care Act of 2010 (ACA) imposed an important constraint on health insurers: if the medical loss ratio (MLR), determined as the ratio of claims paid to premiums collected, declined below certain legislative targets, the insurer would be obliged to rebate a portion of the premiums to the customer. It might be expected that this increase in the MLR would result in a decrease in premium dollars available to cover selling, general and administrative costs (SG&A) and a concomitant decrease in profits. However, there is earlier evidence that SG&A “cost stickiness” presents a counter-effect in this instance: namely, that an increase in SG&A costs per each dollar of revenue increase is more than the magnitude of a decrease in SG&A costs per each dollar of revenue decrease. In this context, this paper offers the first preliminary evidence of the impact of the MLR regulatory change on SG&A cost stickiness in the health insurance industry.Applying the Anderson et al. (2003) methodology, our sample of publicly-traded health insurers shows evidence of significant mitigation of the SG&A cost stickiness after the implementation of the ACA medical loss ratio rules and that in periods of revenue declines, SG&A costs decreased more significantly post-ACA than pre-ACA. These results further illustrate the tension created by regulatory policy designed to improve healthcare cost efficiency and its impact on the profit seeking activities of for-profit healthcare enterprises. Thus, this paper contributes to both healthcare and accounting literature by documenting a significant effect of regulatory policy on managerial decisions regarding cost control.     

Market power in distribution and pass‐through for consumers and producers

We examine the differential pass‐through of import prices into consumer and producer prices. We develop a framework with distribution costs and distribution market power. We then examine pass‐through from import prices to consumer and producer prices in the euro area using the U.S. import price as instrument. We find that pass‐through rates to producer prices are more sensitive to changes in distribution margins than pass‐through to consumer prices. Furthermore, only a portion of import price changes translate into domestic price changes limiting potential consumer benefits from tariff liberalization, with market power in distribution services being one important factor reducing pass‐through.     

Sensitivity and specificity of the Mini-Mental State Examination in the Mexican population

The Mini-Mental State Examination (MMSE) is a rapid, easy-to-administer test for the assessment of cognition functions. It is widely used in clinical practice and in applied research. In this study, we aimed to establish a standard for the Mexican population similar to the ones produced for other relevant populations. We also analysed the effects of demographic variables which regularly induce bias in responses on performance tests, and then, on the basis of the results, implemented a series of corrections to the MMSE to compensate for the usual effects of age and years of formal education. We thus generated a new scale, the adjusted MMSE (AMMSE). We established the maximum sensitivity point to discriminate between the normal population and subjects diagnosed with dementia (vascular and Alzheimer’s). The study provides sensitivity and specificity estimates of this subject-standardized tool in order to reduce the probability of false positives and negatives in the Mexican population.     

Risks at Work: The Demand and Supply Sides of Government Redistribution

To comprehend how the welfare state adjusts to economic shocksit is important to get a handle on both the genesis of popularpreferences and the institutional incentives for governmentsto respond to these preferences. This paper attempts to do both,using a general theoretical framework and detailed data at boththe individual and national levels. In a first step, we focuson how risk exposure and income are related to preferences forredistribution. To test our hypotheses, we extract detailedrisk-exposure measures from labour-force surveys and marry themto cross-national opinion survey data. Results from analysisof these data attest to the great importance of risks withinthe labour market in shaping popular preferences for redistributiveefforts by governments. In a second step, we turn our attentionto the supply side of government redistribution. Institutions,we argue, mediate governments' reactions to redistributionaldemands following economic shocks. Using time-series cross-countrydata, we demonstrate how national training systems, and electoralinstitutions, as well as partisanship, shape government responses. Footnotes ¹ E-mail addresses: tom{at}wz-berlin.de; iversen{at}fas.harvard.edu;pr9{at}duke.edu     

Effects of a short-term linguistic class on communication competence of international nurses: implications for practice, policy, and research

International nurses face a host of challenges in their transition and adaptation to the U.S. health care environment. Language and communication barriers have been ranked consistently as a top concern by employers, regulatory agencies, and international nurses themselves. Researchers in this study examined the effects of a 10-week linguistic class on the reduction of phonologic errors affecting foreign accent in a sample of international nurses. The linguistic course appeared to be effective in improving the international nurses' linguistic competence by reducing their phonologic errors significantly. Moreover, the intervention narrowed the linguistic gap between international nurses from non-English and English-speaking countries. Findings from this study have important implications for practice, policy, and research regarding quality of care, as well as for the transition, job satisfaction, and retention of international nurses.     

Returns to spending on agricultural extension: the case of the National Agricultural Advisory Services (NAADS) program of Uganda†

The aim of this paper is to assess the direct and indirect impacts of the agricultural extension system of Uganda, the National Agricultural Advisory Services (NAADS) program, on household agricultural income. Data from two rounds of surveys of Ugandan rural farm‐households conducted in 2004 and 2007, as well as different program evaluation methods and model specifications, are used to estimate impacts and compute a rate of return. The direct and indirect impact of the program is estimated at 37–95% and 27–55% increase in per capita agricultural gross revenue between 2004 and 2007 for households participating directly and indirectly in the program, respectively, compared to nonparticipants. The rate of return on the program's expenditures is estimated at 8–49%. The program has been relatively more effective among male‐headed, larger, and asset‐poor households, as well as those taking up noncrop high‐value enterprises and living further away from financial services, all‐weather roads, and markets or located in the Eastern and Northern Regions. Policy implications of the results are drawn.     

The influence of social institutions on managers’ concept of trust: Implications for trust-building in Sino-German relationships

Trust has predominantly been seen as a universal construct. Recent research suggests that members of different cultures vary in their understanding of trust. These variations are mostly attributed to the national institutional environment. In describing China and Germany's institutional environments, we emphasize the fundamental institutional differences reflected in their managers’ conceptualizations of trust. Based on 45 interviews with Chinese and German managers, we identify shared elements in their concepts of trust that are likely to foster Sino-German trust development, but also two important dissimilarities which can hinder the development of trust in these relationships.     

Innovationskommunikation 2.0 — Das Beispiel Apple iPhone

Zusammenfassung  Das iPhone ist laut TIME Magazine die Innovation des Jahres 2007. über das innovative Telefon wurde intensiv in den digitalen und analogen Medien berichtet. Apple schaffte es im Gegensatz zu vielen Konkurrenten durch eine gezielte Innovationskommunikation bei potenziellen K?ufern bereits weit vor der offiziellen Markteinführung Wissen über den Namen, das Design und die Funktionalit?ten des iPhones aufzubauen.