The economic impact of acute coronary syndrome on length of stay: an analysis using the Healthcare Cost and Utilization Project (HCUP) databases

Objective:

To assess the economic impact of initial and repeat hospitalizations associated with acute coronary syndrome (ACS) over 1 year (2009).

Design and methods:

National- and state-level data on length of stay (LOS) and related charges for ACS-associated hospital admissions were assessed using two Healthcare Utilization Project databases. The first, the Nationwide Inpatient Sample (NIS), provided clinical and resource use information from ～8 million hospital stays, representing a 20% stratified sample of ～40 million annual hospital stays in the US in 2009. The second, the State Inpatient Databases, provided 100% of inpatient data from nine states that included both patient age and linked information on multiple patient admissions within the same calendar year. For patients with repeat admissions, the LOS, primary diagnosis, and total charges between the first and subsequent admissions were evaluated. All patients ≥18 years of age with at least one diagnosis of ACS, defined using the International Classification of Diseases, 9th Revision, were included (code 410.xx [except 410.x2], 411.1x and 411.8x). Variables evaluated for each discharge included demographics, cardiovascular events and procedures, LOS, discharge status, and total charges.

Results:

The NIS reported 1,437,735 discharges for ACS in 2009. In this dataset, mean LOS for an initial ACS event was 5.56 days. Patients >65 years of age had the highest numbers of admissions; this group also had the most comorbidities. Approximately 40% of ACS patients with data on repeat visits had more than one admission, >70% of these within 2 months of the primary discharge. Mean charges were $71,336 for the first admission and $53,290 for the second admission.

Conclusion:

Despite a variety of new therapies to prevent ACS, it remains a common condition. Better therapies are called for if the clinical and cost burden of ACS is to be alleviated.     

Excess Capacity and Asymmetric Information in Developing Country Fisheries: The Malaysian Purse Seine Fishery

Excess capacity poses a problem in many developing country fisheries. These countries often pursue a development strategy aimed at expanding capacity under open access. Sustainable development, however, requires management. Principal-agent issues from asymmetric information between the regulator and fishers, which potentially form serious obstacles to fisheries management, arise in the likely forms of management. This article discusses principal-agent issues and examines the principal-agent moral hazard issue, which is due to divorce of ownership and vessel operations. The article also illustrates a method for estimating capacity when information is limited. The Peninsular Malaysian purse seine fishery forms a case study.     

Assessing stock market dependence and contagion

This paper assesses evidence of the linkages and contagion among important stock markets in Latin America (Brazil, Mexico and Argentina), Europe (UK and Germany), Asia (Japan and Singapore) and the USA from 6 September 1995 to 19 April 2013. To accomplish this task, this paper combines copula modelling with time-varying parameters and pair-copula composition of multiple dependence. The bivariate analyses show an asymmetric dependence between the stock markets as well as contagion. In addition, this work proposes a method to assess the linkages and contagion between two stock markets which takes into account the effects of a third stock market. In applying this method, conditioned on the USA market, most of the evidence of contagion between the Latin American or European markets disappears, but important dependence levels still remain.     

Arresting the Killer in the Kitchen: The Promises and Pitfalls of Commercializing Improved Cookstoves

In a shift exemplary of neoliberal approaches to development, major funders of household energy interventions have begun to emphasize market-based stove dissemination over partially subsidized models. Stove promoters are increasingly expected to operate as self-sustaining businesses. This shift is viewed as a way to “scale-up” in order to reach millions of poor households lacking access to clean cooking technologies. Using the case of GIRA, an NGO that has successfully distributed cookstoves in Mexico’s Central Highlands for nearly two decades, we demonstrate how this trend presents challenges for organizations operating effectively with outside funding in highly contextual local conditions.     

European environmental policy between decentralisation and uniformity

Does the European Union require a common environmental policy? While there are a number of arguments in favour of shifting competences for environmental policy to the European level, there are also fields in which decentralised policies appear to make more sense. The following article reviews the pros and cons of centralism and decentralism in European environmental policy and concludes that the Union must integrate elements of both options into its constitutional order.     

Board Connections and Dividend Policy

We examine the role of firm board connectedness in shaping a firm's dividend policy. We show that firms with well-connected boards not only have a higher likelihood of paying dividends in the pooled sample of both dividend payers and non-payers but also pay more dividends in the sample of dividend payers, compared with those with poorly connected boards. Further analysis reveals that the relation between board connectedness and dividend-paying behaviour tends to be economically stronger in firms pre-identified to have more severe agency conflicts, suggesting that well-connected boards tend to use dividends to mitigate agency problems in these firms. These findings are robust to different measures of board connectedness, different dividend payout measures, alternative estimation methods, and tests that account for endogeneity.     

On the role and nature of alliance management capability in family business: Empirical evidence from a developing market

Despite the research on alliance management capability (AMC) has evolved in recent years, we still lack a clear understanding of its antecedents and performance outcomes in the context of family businesses, a setting that is inherently different from a typical firm-to-firm corporation. Collecting data from the Libyan family firms sector, we found that alliance experience, family culture (as internal antecedence), and political instability (as external antecedence) are crucial for AMC development, where the latter has a significant effect on the alliance performance of these firms. We also discuss the theoretical and practical implications of our study.     

Resource abundance,financial crisis and economic growth: did resource‐rich countries fare better during the global financial crisis?

This study examines the role of resource abundance in the cross‐country differences in the impacts of the global financial crisis (GFC) of 2008–2009. Using forecasts from the unobserved components model and exponential smoothing technique, we estimate the output levels a country would reach in 2009 and 2013 in the absence of the GFC, and compare these with the realised output levels. We find large variations in the output losses across 72 countries. The mineral‐rich countries have been found to be in a strong position to survive any adverse shocks stemming from the GFC. Income per capita, trade openness, and institutional quality and government effectiveness are also found to be key factors determining the differences in output loss in the post‐crisis period. These findings have strong implications for resource‐rich countries such as Australia and are expected to shed new light on alternative policy designs and appropriate strategies to deal with any future economic crisis.     

Impact of environmental information disclosure and real estate segments on cost of debt: Evidence from the Chinese real estate industry

The novel part of this paper is to examine the individual and joint effects of the real estate segments (RETs) and environmental information disclosure (EID) on the cost of debt (COD) in the real estate industry in China. Building on extant literature, using 1,250 firm‐year observations from 2006 to 2016 and applying both Feasible General Least Squares and Two‐stage Least Squares Instrumental Variable approaches, we provide evidence that the commercial RET leads to an increase in the COD, while EID leads to a decrease in the COD. The joint effects of the RETs and EID on the COD indicate a significantly positive relationship with the COD. This signifies that even with the increased levels of EID in commercial real estate sectors, its COD is higher than for residential real estate sectors. These findings have important policy implications for environmental risk assessments for real estate sectors, their lending institutions and wider stakeholder groups.