Health insurance subsidies and the expansion of an implicit marriage penalty: a regional comparison of various means-tested programmes

Any subsidy provision for healthcare premiums, including those embedded in Affordable Care Act (ACA), has the potential to result in some couples facing an implicit penalty when married relative to unmarried. To illustrate such consequences of means-tested subsidies of health insurance premiums, we construct hypothetical households earning different levels of income who are eligible for current subsidies in the USA. and compare the estimated implicit marriage penalty faced by these households to the one faced by low-income households who are eligible for various means-tested programmes (e.g. TANF, WIC, SNAP) for each of the 48 contiguous states. We find that, like very low-income households, marriage can potentially penalize couples who receive health insurance premium subsidies by decreasing their overall disposable income by as much as 14%. We find that the ACA increases the number of households subject to marriage penalties embedded in means-tested programmes for low-income couples. This distortion will exist for any future health insurance premium subsidies that are means tested at the household income level.     

Healthcare resource utilization among patients with relapsed multiple myeloma in the UK,France, and Italy

Aims: To assess the real-world healthcare resource utilization (HRU) and costs associated with different treatment regimens used in the management of patients with relapsed multiple myeloma in the UK, France, and Italy.

Methods: Retrospective medical chart review of characteristics, time to progression, level of response, HRU during treatment, and adverse events (AEs). Data collection started on June 1, 2015 and was completed on July 15, 2015. In the 3 months before record abstraction, eligible patients had either disease progression after receiving one of their country’s most commonly prescribed regimens or had received the best supportive care and died. Costs were calculated based on HRU and country-specific diagnosis-related group and/or unit reference costs, amongst other standard resources.

Results: Physicians provided data for 1,282 patients (387 in the UK, 502 in France, 393 in Italy) who met the inclusion criteria. Mean [median] total healthcare costs associated with a single line of treatment were €51,717 [35,951] in the UK, €37,009 [32,538] for France, and €34,496 [42,342] for Italy, driven largely by anti-myeloma medications costs (contributing 95.0%, 90.0%, and 94.2% of total cost, respectively). During active treatment, the highest costs were associated with lenalidomide- and pomalidomide-based regimens. Mean cost per month was lowest for patients achieving a very good partial response or better. Unscheduled events (i.e. not considered part of routine management, whether or not related to multiple myeloma, such as unscheduled hospitalization, AEs, fractures) accounted for 1–9% of total costs and were highest for bendamustine.

Limitations: The use of retrospective data means that clinical practice (e.g. use of medical procedures, evaluation of treatment response) is not standardized across participating countries/centers, and some data (e.g. low-grade AEs) may be incomplete or differently adjudicated/reported. The centers involved may not be fully representative of national practice.

Conclusions: Drug costs are the main contributor to total HRU costs associated with multiple myeloma. The duration of active treatment may influence the average total costs, as well as response, associated with a single line of therapy. Improved treatment outcomes, and reductions in unscheduled events and concomitant medication use may, therefore, reduce the overall HRU and related costs of care in multiple myeloma.     

Financial cycles and fiscal multipliers

We show that fiscal multiplier estimations may be biased by movements in asset and credit markets, as they facilitate spurious correlations of changes in cyclically adjusted revenues and spending with output growth via an identification bias and an omitted variable bias, thus overstating episodes of expansionary consolidations and downplaying contractionary consolidations. When controlling for asset and credit market movements in otherwise standard approaches to identification, we find multipliers to increase on average by 0.3–1 units. Fiscal consolidations are thus more likely to be contractionary and more harmful to growth than expected by some strands of the existing literature.     

ON THE TAXATION OF DURABLE GOODS

This article proposes a dynamic Mirrleesian theory of commodity taxation in the presence of durable goods. A uniform taxation across all goods is suboptimal even when the consumption preferences are separable from labor. If the consumption utility function is strictly concave and durable stocks are adjustable without friction, durable investment should be taxed at a higher rate than the purchase of nondurable goods. With adjustment frictions, the wedge on durable investment depends on substitution effects between durable and nondurable consumption and can be positive or negative. An application suggests that housing investment should face higher tax rates than regular consumption.     

Ethics in Strategic Thinking: Business Processes and the Global Market Collapse

The authors discussed the reasons for the recent economic collapse as caused by the lack of large businesses and global corporations losing touch with the people they serve. Losing touch has caused a distancing of understanding of the customers as people by these businesses and corporations. An antidote to this is that decisions that have to be made in global businesses as well as domestic organizations reflect some level of empathy. The objective is to highlight the fact that these businesses are corporate citizens and in themselves must be aware of the culture in which they conduct themselves. The authors discuss how empathic decision-making can become part of the corporate fabric without losing any sense of appropriate business judgment. A process is defined to enable the empathic process. Finally, a straw man is set up to fund/enable the process while creating a positive and profitable business environment.     

Demand for money in open economies

The demand for real cash balances deduced from an underlying portfolio model of the financial market is shown to depend upon domestic variables and foreign monetary developments. The model is estimated using quarterly postwar data for Canada, Germany, UK and US. There is clear evidence that demand for money is affected not only by changes in domestic variables such as permanent income, domestic interest rate and price expectations but also by fluctuations in exchange rate expectations and foreign interest rates. The conclusion, that domestic monetary policy is fairly ineffective and domestic financial markets are highly vulnerable to changes in foreign financial and monetary developments need to be modified in light of the results presented in this paper.     

K-matrix-class estimators and the full-information maximum-likelihood estimator as a special case

This article presents a unified treatment of simultaneous system estimation. A general class of full-information estimators is proposed, called K-matrix-class (KMC). It is shown that the K-matrix-class includes both full-information maximum-likelihood and three-stage least- squares estimators as special cases and that the k-class can be regarded as a subclass of the K-matrix-class. Conditions under which KMC estimators are consistent (similar to those of the k-class estimators) are given. Furthermore, as a full information-generalization of the double k-class estimators, the double K-matrix-class estimators (DKMC) are proposed.     

Floating exchange rates,expectations and new information

This paper analyzes the relationship between forward exchange rates, future spot rates and new information. A stochastic model of exchange rate determination is used to formally show how unanticipated changes in the exchange rate determinants (or ‘news’) affect the spot rate. The empirical analysis indicates that ‘new information’ plays an important role in explaining the market forecasting error, or difference between the spot rate and the forward rate, determined in the previous period.