Estimates of the direct and indirect cost savings associated with heart disease that could be avoided through dietary change in the United States

Aims: Diets high in saturated fat are associated with elevated risk of heart disease. This study estimates the savings in direct (medical care) costs and indirect (job absenteeism) costs in the US from reductions in heart disease associated with substituting monounsaturated fats (MUFA) for saturated fats.

Materials and methods: A four-part model of the medical care cost savings from avoided heart disease was estimated using data on 247,700 adults from the 2000–2010 Medical Expenditure Panel Survey (MEPS). The savings from reduced job absenteeism due to avoided heart disease was estimated using a zero-inflated negative binomial model of the number of annual work loss days applied to data on 164,577 adults from the MEPS.

Results: Estimated annual savings in medical care expenditures resulting from a switch from a diet high in saturated fat to a high-MUFA diet totaled ～ $25.7 billion (95% CI = $6.0–$45.4 billion) in 2010, with private insurance plans saving $7.9 billion (95% CI?=?$1.8–$14.0 billion), Medicare saving $9.4 billion (95% CI?=?$2.1–$16.7 billion), Medicaid saving $1.4 billion (95% CI?=?Aims: Diets high in saturated fat are associated with elevated risk of heart disease. This study estimates the savings in direct (medical care) costs and indirect (job absenteeism) costs in the US from reductions in heart disease associated with substituting monounsaturated fats (MUFA) for saturated fats.

Materials and methods: A four-part model of the medical care cost savings from avoided heart disease was estimated using data on 247,700 adults from the 2000–2010 Medical Expenditure Panel Survey (MEPS). The savings from reduced job absenteeism due to avoided heart disease was estimated using a zero-inflated negative binomial model of the number of annual work loss days applied to data on 164,577 adults from the MEPS.

Results: Estimated annual savings in medical care expenditures resulting from a switch from a diet high in saturated fat to a high-MUFA diet totaled ～ $25.7 billion (95% CI = $6.0–$45.4 billion) in 2010, with private insurance plans saving $7.9 billion (95% CI?=?$1.8–$14.0 billion), Medicare saving $9.4 billion (95% CI?=?$2.1–$16.7 billion), Medicaid saving $1.4 billion (95% CI?=?$0.2–$2.5 billion), and patients saving $2.2 billion (95% CI?=?$0.5–$3.8 billion). The annual savings in terms of reduced job absenteeism ranges from a lower bound of $600 million (95% CI?=?$100 million to $1.0 billion) to an upper bound of $1.2 billion (95% CI?=?$0.2–$2.1 billion) for 2010.

Limitations: The data cover only the non-institutionalized population. Decreased costs due to any decreases in the severity of heart disease are not included. Cost savings do not include any reduction in informal care at home.

Conclusions: Diets high in saturated fat impose substantial medical care costs and job absenteeism costs, and substantial savings could be achieved by substituting MUFA for saturated fat.     

Common purpose and divided loyalties: the risks and rewards of cross-sector collaboration for academic and government researchers

International evidence shows that research is increasingly being carried out in organisational forms built around cross-sectoral (government, academic and business) and transdisciplinary teams with well-defined national social, economic or environmental objectives in view. As a result, new and unfamiliar forms of organisational arrangements for research are emerging within universities and elsewhere. These collaborative research centres have been variously termed 'hybrid' or 'parasitic'. This paper draws upon around 30 in-depth interviews with participants from selected Australian Cooperative Research Centres (CRC). It examines how researchers reconcile the many demands of their dual role, first, as a government researcher or academic, and second as a committed participant in an industry-collaborative research centre. These collaborations go beyond 'applied research' to span fundamental research and immediately useful knowledge. But reward systems and performance measures for academic researchers are still founded largely on 'discovery', while those for government researchers are based upon 'application'. The risk is that researchers will be deflected by the collaboration in ways that conflict with their institutional responsibilities. The paper reports work analysing the management strategies used by the CRCs and their public sector partners to ensure that their common goals are achieved while preserving their institutional interests and the expectations of their research staff. The aim is to identify effective ways of managing the various 'risks' of cross-sector collaborative research and development (R&D) in Australia and more widely.     

An integrated approach to the development of continuous simulations

An integrated approach to the development of Forrester-style simulation models is described. The approach incorporates the concept of an interaction matrix to assist in the development of causal loop diagrams and Dynamo flow diagrams. The interaction matrix is derived from the fundamental notions of system dynamics. Premised upon the presumption that a computer-aided procedure for model formulation can expedite, systematize, and operationalize the model formulation process, the integrated approach utilizes the interaction matrix as a data structure within the computer. An algorithm designed to interface with a remote terminal (such as a CRT display) determines the interaction matrix by interrogating a user until sufficient information about the problem of interest has been obtained. This algorithm is also described in the paper. The interrogations both motivate and facilitate the determination of quantities to be included as well as couplings between the quantities. When a quantity or coupling is designated by a user, the algorithm “knows” its identity at the time of user origination. Both algorithm and matrix are illustrated through recourse to a text-book example and the paper concludes with a summarizing discussion of the possible contribution of such an approach.     

Matrix management in hospitals: testing theories of matrix structure and development.

A study of 315 hospitals with matrix management programs was used to test several hypotheses concerning matrix management advanced by earlier theorists. The study verifies that matrix management involves several distinctive elements that can be scaled to form increasingly complex types of lateral coordinative devices. The scalability of these elements is evident only cross-sectionally. The results show that matrix complexity is not an outcome of program age, nor does matrix complexity at the time of implementation appear to influence program survival. Matrix complexity, finally, is not determined by the organization's task diversity and uncertainty. The results suggest several modifications in prevailing theories of matrix organization.     

The Theory of Socially Embedded Games: The Mathematics of Social Relationships,Rule Complexes,and Action Modalities

In their classic work, Von Neumann and Morgensterndefined a game as simply the totality of the rules which describe it. Theydid not, however, elaborate a theory of rules. Such considerations lead toconceptualizing rules and rule configurations as mathematical objects, specifyingthe principles for combining rules, developing the theory of revising,replacing, and, in general transforming rules and rule complexes. Themathematics is based on contemporary developments at the interface ofmathematics, logic, and computer science. This article, drawing on themathematical theory of rules and rule complexes, extends and generalizes gametheory (GGT). The theory of rule complexes is used to conceptualize andanalyze diverse social relationships, roles, and games as particulartypes of rule complexes. A social role, for instance, is the major basisof an individual's action in a game. It consists of at least four majorcomponents – which are mathematical objects – in the determinationof action: value complex, model of reality (including beliefs and knowledgebases), a repertoire of acts, routines, programs, and strategies, and modalities,role-specific algorithms for determininig or generating action in gamesettings. The article focuses on three types of action modality routineor habitual, normative, andinstrumental modalities. The theory: (1) provides a cultural/institutionalbasis for a theory of gameswhere games, social relationships, and rolesare formalized in terms of rule complexes; (2) explains human action as a formof rule application or rule-following action, which underlies allmodalities of action; (3) formulates the theory that actors construct an action or make choices amongalternative actions by making comparisons and judging similarity (ordissimilarity) between an option or options considered and their norms and values,and, in general, determine whether or not, and to what degree, a value,norm, or goal will be realized or satisfied; (4)reconceptualizes ``game' as a social form and makes a distinction between open and closed games.     

Changes in audit effort and changes in auditors’ disclosures of risks of material misstatement

This paper investigates whether auditors' year-to-year modification to risks of material misstatements (RMMs) in extended auditors' reports (EARs) are associated with changes in underlying audit effort, as proxied by changes in audit fees. We examine the dynamics of RMMs over time in terms of adding or dropping specific RMMs. Our main results show that, on average, audit fees increase more from the previous year's fees when more RMMs are added to the current year's EAR. This increase is partially offset by dropping RMMs that were disclosed in the previous year, but changes in audit fees are not significantly affected by dropping RMMs without adding new RMMs. Further analysis suggests the effect of added RMMs is attributable to “new” RMMs originating with the auditor and that added RMMs that were previously known, based on related disclosures in the prior year's audit committee report, do not significantly impact on changes in audit fees. Overall, our results suggest that changes in the choice of RMMs included in EARs reflect changes in underlying audit effort.