Economic burden of sarcoidosis in a commercially-insured population in the United States

Background: Sarcoidosis is a multi-system inflammatory disorder characterized by the presence of non-caseating granulomas in involved organs. Patients with sarcoidosis have a reduced quality-of-life and are at an increased risk for several comorbidities. Little is known about the direct and indirect cost of sarcoidosis following the initial diagnosis.

Aims: To provide an estimate of the healthcare resource utilization (HCRU) and costs borne by commercial payers for sarcoidosis patients in the US.

Methods: Patients with a first diagnosis of sarcoidosis between January 1, 1998 and March 31, 2015 (“index date”) were selected from a de-identified privately-insured administrative claims database. Sarcoidosis patients were required to have continuous health plan enrollment 12 months prior to and following their index dates. Propensity-score (1:1) matching of sarcoidosis patients with non-sarcoidosis controls was carried out based on a logistic regression of baseline characteristics. Burden of HCRU and work loss (disability days and medically-related absenteeism) were compared between the matched groups over the 12-month period following the index date (“outcome period”).

Results: A total of 7,119 sarcoidosis patients who met the selection criteria were matched with a control. Overall, commercial payers incurred $19,714 in mean total annual healthcare costs per sarcoidosis patient. The principle cost drivers were outpatient visits ($9,050 2015 USD, 46%) and inpatient admissions ($6,398, 32%). Relative to controls, sarcoidosis patients had $5,190 (36%) higher total healthcare costs ($19,714 vs $14,524; p?p?p?Background: Sarcoidosis is a multi-system inflammatory disorder characterized by the presence of non-caseating granulomas in involved organs. Patients with sarcoidosis have a reduced quality-of-life and are at an increased risk for several comorbidities. Little is known about the direct and indirect cost of sarcoidosis following the initial diagnosis.

Aims: To provide an estimate of the healthcare resource utilization (HCRU) and costs borne by commercial payers for sarcoidosis patients in the US.

Methods: Patients with a first diagnosis of sarcoidosis between January 1, 1998 and March 31, 2015 (“index date”) were selected from a de-identified privately-insured administrative claims database. Sarcoidosis patients were required to have continuous health plan enrollment 12 months prior to and following their index dates. Propensity-score (1:1) matching of sarcoidosis patients with non-sarcoidosis controls was carried out based on a logistic regression of baseline characteristics. Burden of HCRU and work loss (disability days and medically-related absenteeism) were compared between the matched groups over the 12-month period following the index date (“outcome period”).

Results: A total of 7,119 sarcoidosis patients who met the selection criteria were matched with a control. Overall, commercial payers incurred $19,714 in mean total annual healthcare costs per sarcoidosis patient. The principle cost drivers were outpatient visits ($9,050 2015 USD, 46%) and inpatient admissions ($6,398, 32%). Relative to controls, sarcoidosis patients had $5,190 (36%) higher total healthcare costs ($19,714 vs $14,524; p?<?0.001). Sarcoidosis patients also had significantly more work loss days (15.9 vs 11.3; p?<?0.001) and work loss costs ($3,288 vs $2,527; p?<?0.001) than matched controls. Sarcoidosis imposes an estimated total direct medical cost of $1.3–$8.7 billion to commercial payers, and an indirect cost of $0.2–$1.5 billion to commercial payers in work loss.

Conclusions: Sarcoidosis imposes a significant economic burden to payers in the first year following diagnosis.     

A Capital Controversy in Early Twentieth Century: Veblen vs. Clark

This article aims to assess the debate between John Bates Clark and the “old” institutionalist scholars — Thorstein Veblen, above all — with particular reference to the nature of capital and the functioning of the labor market. Although studies on both authors are numerous, relatively little attention has been paid to finding the crucial elements at the heart of their radical disagreement. A.J. Cohen (2014 Cohen, A.J. “Veblen Contra Clark and Fisher: Veblen-Robinson-Harcourt Lineages in Capital Controversy and Beyond.” Cambridge Journal of Economics 38, 6 (2014): 1493-1515.[Crossref], [Web of Science ®] , [Google Scholar]) convincingly argues that Veblen’s attack on Clark is in the center of the capital controversy of the 1960s and 1970s. We propose an extension of this argument, based on the idea that Veblen’s attack on Clark follows three steps. First, Veblen defined capital in money terms and, at the same time, he saw it as the accumulated technological and institutional experience of a community. Second, insofar as capital cannot be reduced to a stock of physical goods, it is logically impossible to derive a function of the marginal labor productivity from the existing stock of capital. Third, insofar as the marginal productivity of labor cannot be measured, it follows that the equality between real wage and marginal labor productivity cannot logically hold. It also follows that, since it does not exist, this equality cannot be used as a basis for establishing that the equilibrium wage is a just wage.     

The interaction effect of gender and ethnicity in loan approval: A Bayesian estimation with data from a laboratory field experiment

Microfinance targets women and uses loan provision as a tool for empowerment, which translates into better household nutrition, improved education, and a scale down of domestic violence. However, ethnic discrimination in microfinance may exist in countries with a segregated indigenous population. We assessed this possibility with a field experiment in Bolivia. The controlled laboratory experiment evaluated whether credit officers rejected microloan applications based on the interaction effect of ethnicity and gender of potential borrowers. Point estimates of a Bayesian mixed‐effects logistic regression, estimated with the experimental data, indicate that nonindigenous women have double the chance of loan approval, but indigenous women have only 1.5 times the chance of loan approval when compared with men. While the findings about gender are limited, the evidence for the interaction of gender and ethnicity is more robust and suggests the existence of positive taste‐based discrimination favorable for nonethnic women in Bolivia. We conclude that the affirmative actions towards women promoted by development agencies and microfinance institutions must not overlook ethnicity as an important factor for financial policies of sustainable development. In practice, these policies should be aimed at identifying and reducing both social desirability bias and the structural barriers to financial inclusion that indigenous women may face when trying to obtain access to a loan.     

NEW ORGANIZATIONAL MODELS IN EUROPEAN LOCAL PUBLIC TRANSPORT: FROM MYTH TO REALITY*

ABSTRACT: The Europeanization of public services is frequently considered to have created pressure for Member States to progressively converge towards a new dominant organizational model, based on deregulation, de‐integration and privatization. However, while in some sectors European directives played a crucial role in boosting a common evolutionary path, in other cases, mainly related to local public services, this influence remained feeble and more uncertain. The empirical insight on EU Local Public Transport Services carried out in this paper aims at investigating if and to what extent this new dominant paradigm actually emerges, or if and to what extent more fragmented and heterogeneous outcomes prevail. The main outcome is that the public role in Local Public Transport is still widespread and that a major theoretical and analytical focus should be directed to the ability of the principal‐competent public administration to play its role in an effective and sound manner, while often too much attention is paid to the characteristics of the agent‐operator (public‐private, big or small, foreign or national, etc.).     

Digitalisation,automation and upgrading in global value chains – factory economy actors versus lead companies

This article investigates the differences in the application and impact of digital technologies between manufacturing subsidiaries and lead companies, the principal orchestrators of global automotive value chains. Utilising a dataset of 10 in-depth interviews with automotive industry actors, we analyse headquarters–subsidiary differences in the patterns of digitalisation-driven upgrading. A theoretical framework is offered that explains why the significant upgrading achievements of manufacturing subsidiaries deploying industry 4.0 technologies will not reduce the gap between lead companies and manufacturing subsidiaries in terms of value generation. We show that the concept of ‘industry 4.0’ is much narrower than that of ‘digitalisation’ and transition to smart factories is only part of the digital transformation story. Industry 4.0 technologies contribute to the upgrading of operations, and enable subsidiaries to take on production-related knowledge-intensive assignments (functional upgrading). Conversely, digitalisation serves lead companies’ strategic differentiation efforts, and facilitates achieving competitive advantage: the latter are crucial for value capture.     

Pensions reforms,workforce ageing and firm-provided welfare

This paper investigates the impact of an exogenous increase in the legal retirement age on the firms’ propensity to provide welfare services voluntarily to their employees. To this purpose we exploit a unique information derived from the Rilevazione su Imprese e Lavoro (RIL), a survey conducted in 2015 on a large and representative sample of Italian firms. Applying different regression models we show that firms which were forced to give up previously planned hirings because of the Law 201/2011 (the so-called ‘Fornero pension reform’), increased the probability of providing welfare services at workplace. By referring to the sociological, human resource management and economic literature we then argue that a sudden increase in the legal retirement age may motivate the employers to establish welfare schemes as a way to cope with an ageing workforce. Our findings also hold when propensity score matching methods are used in order to control for sample selection issues.     

Bidding for Firms with Unknown Characteristics

When a region successfully attracts a firm by offering subsidies, the firm often commits itself to performance targets in terms of employment. In this paper, we interpret these firm‐specific targets as a consequence of incomplete information. We analyze a model of two regions that compete for a firm, assuming that the firm's productivity is ex ante unknown. We show that performance targets often induce overemployment in high‐productivity firms, and that tax credits are often superior to lump‐sum payments. Moreover, when regions differ in wage rates, the low‐wage region wins the bid and has a higher surplus than under complete information. Finally, we show that, under incomplete information, bidding might not lead to efficient firm location.     

Taxation and the quality of entrepreneurship

We study the effect of taxation on entrepreneurship, investigating how taxes affect both the number of start-ups and their average quality. We show theoretically that even with risk neutral agents and no tax evasion progressive taxes can increase entrepreneurial entry, while reducing average firm quality. So called “success taxes” encourage start-ups with lower value business ideas by reducing the option value of pursuing better projects. This suggests that the most common measure used in the literature, the likelihood of entry into self-employment, may underestimate the adverse effect of taxation.