Transnational regulation of professional services: Governance dynamics of field level organizational change

This paper examines the role of large accounting firms in the emergence of a transnational regulatory field in professional services. We use neo-institutional theory to illuminate the process by which new fields are created. We observe a shift in the structural boundaries of professional regulation to include new actors, specifically Big Four accounting firms and non-governmental organizations. We also observe a shift in regulatory logics in which historical efforts to separate professional practice from commercial interest are embraced rather than suppressed. New logics also include pressures to adopt new occupational identities. Finally we describe a shift in institutional power structures from coercive structures of domination to inclusive power structures of membership and identity.     

Internet cautions: Experimental games with internet partners

We report the results of experiments conducted over the internet between two different laboratories. Each subject at one site is matched with a subject at another site in a trust game experiment. We investigate whether subjects believe they are really matched with another person, and suggest a methodology for ensuring that subjects’ beliefs are accurate. Results show that skepticism can lead to misleading results. If subjects do not believe they are matched with a real person, they trust too much: i.e., they trust the experimenter rather than their partner. JEL Classification C9     

CEO Tenure, Board Composition, and Regulation

We examine the effect of deregulation in the 1970s and 1980s on the size of the board of directors, its composition, and on CEO tenure. Using panel data techniques, we consider those effects in the aggregate and for individual industries while controlling for firm size, CEO age, time and firm-specific effects. We conclude that deregulation significantly reduced the number of outsiders and the number of directors, but had little effect on the proportion of outsiders. We then examine the effect of deregulation on CEO tenure using hazard analysis. We find that deregulation increased the hazard rate, or reduced the tenure of CEOs.     

Cost-impact of cardiac magnetic resonance imaging with Fast-SENC compared to SPECT in the diagnosis of coronary artery disease in the U.S

Aims: The purpose of this study is to assess the economic cost differences and the associated treatment resource changes between the developing coronary artery disease (CAD) diagnostic tool fast strain-encoded cardiac imaging (Fast-SENC) and the current commonly used stress test single-photon emission computed tomography (SPECT).

Materials and methods: A “payer perspective” model was created first, consisting of long-term and short-term components that used a hypothetical cohort of patients of average age (60.8?years) presenting with chest pain and suspected CAD to assess cost-impact. A cost impact model was then built that assessed likely savings from a “hospital perspective” from substituting Fast-SENC for a portion of SPECTs assuming an average number of annual SPECT tests performed in US hospitals.

Results: In the payer model, using Fast-SENC followed by coronary angiography (CA) and percutaneous coronary intervention (PCI) treatment when necessary is less costly than the SPECT method when considering both direct and indirect costs of testing. Expected costs of the Fast-SENC were between $2,510 and $2,632 per correct diagnosis, while expected costs for the SPECT were between $3,157 and $4,078. Fast-SENC reduced false positives by 50% and false negatives by 86%, generating additional cost savings. The hospital model showed total costs per CAD patient visit of $825 for SPECT and $376 for Fast-SENC.

Limitations: Limitations of this study are that clinical data are sourced from other published clinical trials on how CAD diagnostic strategies impact clinical outcome, and that necessary assumptions were made which impact health outcomes.

Conclusion: The lower cost, higher sensitivity and specificity rates, and faster, less burdensome process for detecting CAD patients make Fast-SENC a more capable and economically beneficial stress test than SPECT. The payer model and hospital model demonstrate an alignment between payer and provider economics as Fast-SENC provides monetary savings for patients and resource benefits for hospitals.